Downloadable datasets for a patient monitoring system

ABSTRACT

In general, this disclosure describes techniques for remotely monitoring the health of an ambulatory patient. As described herein, an ambulatory patient may interact with a monitoring device that is located at the patient&#39;s home. The monitoring device may prompt the patient to provide responses to health-related questions or requests for physiological characteristics and may upload the responses. A health care professional may then use the responses to evaluate the health of the patient. A set of firmware instructions stored on the monitoring device may cause the monitoring device to perform these functions. These firmware instructions remain the same even when the monitoring device downloads new prompts.

RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No.11/345,956 filed on Feb. 2, 2006, entitled “MULTIUSER WELLNESS PARAMETERMONITORING SYSTEM,” which is a continuation-in-part of U.S. applicationSer. No. 11/230,810 filed on Sep. 19, 2005, entitled “SYSTEM, METHOD,AND APPARATUS FOR COMBINING INFORMATION FROM AN IMPLANTED DEVICE WITHINFORMATION FROM A PATIENT MONITORING APPARATUS,” now U.S. Pat. No.7,577,475, which is a continuation-in-part of U.S. application Ser. No.11/181,682 filed on Jul. 13, 2005, entitled “SYSTEM, METHOD, ANDAPPARATUS FOR AUTOMATED INTERACTIVE VERIFICATION OF AN ALERT GENERATEDBY A PATIENT MONITORING DEVICE,” which is a continuation-in-part of U.S.application Ser. No. 10/746,325 filed on Dec. 23, 2003, entitled “WEIGHTLOSS OR WEIGHT MANAGEMENT SYSTEM,” which is a continuation-in-part ofU.S. application Ser. No. 10/093,948 filed on Mar. 7, 2002, entitled“REMOTE SYSTEM FOR AMBULATORY COPD PATIENTS,” now U.S. Pat. No.7,945,451, which is a continuation-in-part of U.S. application Ser. No.09/949,197 filed on Sep. 7, 2001, now U.S. Pat. No. 6,755,783 entitled“APPARATUS AND METHOD FOR TWO-WAY COMMUNICATION IN A DEVICE FORMONITORING AND COMMUNICATING WELLNESS PARAMETERS OF AMBULATORYPATIENTS,” which is a continuation-in-part of U.S. application Ser. No.09/293,619 filed on Apr. 16, 1999, now U.S. Pat. No. 6,290,646 entitled“APPARATUS AND METHOD FOR MONITORING AND COMMUNICATING WELLNESSPARAMETERS OF AMBULATORY PATIENTS,” all of which are hereby incorporatedby reference in their entirety.

BACKGROUND

There is a need in the medical profession for an apparatus and methodcapable of monitoring and transmitting physiological and wellnessparameters of patients to a remote site where a medical professionalcaregiver evaluates such physiological and wellness parameters.Specifically, there is a need for an interactive apparatus that iscoupled to a remote computer such that a medical professional caregivercan supervise and provide medical treatment to remotely locatedpatients.

There is needed an apparatus that monitors and transmits physiologicaland wellness parameters of patients to a remote computer, whereby amedical professional caregiver evaluates the information and provokesbetter overall health care and treatment for the patient. Accordingly,such an apparatus can be used to prevent unnecessary hospitalizations ofsuch patients.

Also, there is needed an apparatus for monitoring and transmitting suchphysiological and wellness parameters that is easy to use and that isintegrated into a single unit. For example, there is a need for apatient monitoring apparatus that comprises: a transducing device forproviding electronic signals representative of measured physiologicalparameters, such as weight; an input/output device; and a communicationdevice as a single integrated unit that offers ambulatory patients easeof use, convenience and portability.

Patients suffering from chronic diseases, such as chronic heart failure,will benefit from such home monitoring apparatus. These patientsnormally undergo drug therapy and lifestyle changes to manage theirmedical condition. In these patients, the medical professional caregivermonitors certain wellness parameters and symptoms including: weakness,fatigue, weight gain, edema, dyspnea (difficulty breathing or shortnessof breath), nocturnal cough, orthopnea (inability to lie flat in bedbecause of shortness of breath), and paroxysmal nocturnal dyspnea(awakening short of breath relieved by sitting or standing); and bodyweight to measure the response of drug therapy. Patients will alsobenefit from daily reminders to take medications (improving compliance),reduce sodium intake and perform some type of exercise. With theinformation received from the monitoring device, the medicalprofessional caregiver can determine the effectiveness of the drugtherapy, the patient's condition, whether the patient's condition isimproving or whether the patient requires hospitalization or an officeconsultation to prevent the condition from getting worse.

Accordingly, there is needed an apparatus and method for monitoring thepatients from a remote location, thus allowing medical professionalcaregivers to receive feedback of the patient's condition without havingto wait until the patient's next office visit. In addition, there isneeded an apparatus and method that allows medical professionalcaregivers to monitor and manage the patient's condition to prevent therehospitalization of such patient, or prevent the patient's conditionfrom deteriorating to the point where hospitalization would be required.As such, there are social as well as economic benefits to such anapparatus and method.

The patient receives the benefits of improved health when theprofessional caregiver is able to monitor and quickly react to anyadverse medical conditions of the patient or to any improper responsesto medication. Also, society benefits because hospital resources willnot be utilized unnecessarily.

As a group, patients suffering from chronic heart failure are the mostcostly to treat. There are approximately 5 million patients in theU.S.A. and 15 million worldwide with chronic heart failure. Themortality rate of patients over 65 years of age is 50%. Of those thatseek medical help and are hospitalized, 50% are rehospitalized within 6months. Of these, 16% will be rehospitalized twice. The patients thatare hospitalized spend an average of 9.1 days in the hospital at a costof $12,000.00 for the period. Accordingly, there is a need to reduce therehospitalization rate of chronic heart failure patients by providingimproved in-home patient monitoring, such as frequently monitoring thepatient's body weight and adjusting the drug therapy accordingly.

Approximately 60 million American adults ages 20 through 74 areoverweight. Obesity is a known risk factor for heart disease, high bloodpressure, diabetes, gallbladder disease, arthritis, breathing problems,and some forms of cancer such as breast and colon cancer. Americansspend $33 billion dollars annually on weight-reduction products andservices, including diet foods, products and programs.

There is a need in the weight management profession for an apparatus andmethod capable of monitoring and transmitting physiological and wellnessparameters of overweight/obese patients to a remote site where a weightmanagement professional or nutritionist evaluates such physiological andwellness parameters. Specifically, there is a need for an interactiveapparatus that is coupled to a remote computer such that a weightmanagement professional or nutritionist can supervise and providenutritional guidance to remotely located individuals.

The apparatus allows overweight individuals to participate in a weightloss/management program with accurate weight monitoring from home. Theapparatus improves the convenience for the individual participant byeliminating the need to constantly commute to the weight managementcenter and “weigh-in.” Furthermore, the individual can participate in aweight management program while under professional supervision from theprivacy and comfort of their own home. Moreover, the apparatus allowsthe weight management professional to intervene and adapt theindividual's diet and exercise routine based on the weight and wellnessinformation received.

Employers and individuals are subject to increasing health costexposure. Premiums for employer-based health insurance have risen byover 10 percent each year for the past four years. Employees areincreasingly being asked to shoulder additional healthcare costs in theform of copayments, coinsurance, and other cost sharing mechanisms. Amethod that facilitates cutting the overall cost and/or frequency ofclinic visits for a large number of individuals is needed, particularlyfor preventative or maintenance healthcare needs.

Persons often wait until a clear health issue develops prior toscheduling a clinical visit. Cost, inconvenience, and discomfort arecommon reasons why such persons allow minor health issues to developinto much more serious issues requiring substantially higher expense.Such health issues can be based on a variety of hereditary orenvironmental factors. As such, there is a need for a system that tracksa person's historical health data, asks questions related to healthrelated risk factors, and carefully tailors interaction with a patientbased on that patient's risk factors and historical health data.

For the foregoing reasons, there is a need for an apparatus, system andmethod capable of monitoring and transmitting physiological and wellnessparameters of ambulatory patients, such as body weight, blood pressure,blood glucose levels, heart rate, or other parameters, to a remotelocation where a medical professional caregiver, weight managementprofessional or nutritionist can evaluate and respond to the patient'smedical wellness condition.

SUMMARY

In general, this disclosure describes techniques for remotely monitoringthe health of an ambulatory patient. As described herein, an ambulatorypatient may interact with a monitoring device that is located at thepatient's home. The monitoring device may prompt the patient to provideresponses to health-related questions or requests for physiologicalcharacteristics and may upload the responses. A health care professionalmay then use the responses to evaluate the health of the patient. A setof firmware instructions stored on the monitoring device may cause themonitoring device to perform these functions. These firmwareinstructions remain the same even when the monitoring device downloadsnew prompts.

The techniques described in this disclosure may have severaladvantageous qualities. For instance, because the firmware does notchange when the patient monitoring device downloads datasets, it may beunnecessary for the patient monitoring device to download additionalinstructions that enable the patient monitoring device to presentprompts in the datasets, receive responses to prompts in the datasets,and to upload responses to the prompts in the datasets. As a result,less data needs to be transferred to the patient monitoring device. Thismay save time and electrical energy. Saving electrical energy may beimportant when the patient monitoring device is a handheld device suchas a smart phone or a personal digital assistant. In another example, itmay be advantageous for the firmware not to change because the additionof additional code may result in an increased likelihood of introducingsoftware bugs. Furthermore, this example implementation may beadvantageous because it may be easier to write prompts in an extensiblemarkup language (XML) document than it is to write questions withaccompanying instructions for the presentation of the prompts.

The techniques described in this disclosure may be implemented in manydifferent ways. For instance, the techniques may be implemented as amethod that comprises storing a set of firmware instructions in apatient monitoring device. The method also comprises repeatedlyexecuting, on the patient monitoring device, instructions in the storedset of firmware instructions that cause the patient monitoring deviceto: download a prompt from a monitoring server via a communicationsnetwork; present the prompt to a patient who is being monitored by thepatient monitoring device; receive a response to the prompt; and uploadthe response, the response being uploaded to the monitoring server.After the patient monitoring device finishes executing instructions inthe stored set of firmware instructions, the stored set of firmwareinstructions is the same as before the patient monitoring deviceexecuted the instructions in the stored set of firmware instructions.

In another example implementation, a computer-readable medium comprisesa stored set of firmware instructions that, when executed by a processorof a patient monitoring device, cause the patient monitoring device todownload a prompt from a monitoring server via a communications network.The firmware instructions also cause the patient monitoring device topresent the prompt to a patient who is being monitored by the patientmonitoring device. In addition, the firmware instructions cause thepatient monitoring device to receive a response to the prompt. Thefirmware instructions also cause the patient monitoring device to uploadthe response, the response being uploaded to the monitoring server.After the processor finishes executing instructions in the stored set offirmware instructions, the stored set of firmware instructions is thesame as before the processor executed the instructions in stored set offirmware instructions.

In another example implementation, a system comprises a monitoringserver. The system also comprises a patient monitoring device thatcomprises a read-only memory that stores a set of firmware instructions.The patient monitoring device also comprises a processor that executesinstructions in the set of firmware instructions. When the processorexecutes the instructions in the set of firmware instructions, theinstructions cause the patient monitoring device to: download a promptfrom the monitoring server, present the prompt to a patient who is beingmonitored by the patient monitoring device; receive a response to theprompt, and upload the response, the response being uploaded to themonitoring server. After the processor finishes executing theinstructions in the set of firmware instructions, the set of firmwareinstructions is the same as before the processor executed theinstructions in set of firmware instructions. The system also comprisesa communications network that facilitates communication between themonitoring server and the patient monitoring device, the patientmonitoring device downloading the prompt via the communications networkand uploading the response via the communications network.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects and advantages of the invention willbecome better understood with regard to the following description,appended claims and accompanying drawings where:

FIGS. 1A-E illustrates several embodiments of the monitoring apparatusin accordance with the invention;

FIG. 2 illustrates a monitoring apparatus with a support member inaccordance with one embodiment of the invention;

FIG. 3 illustrates a monitoring apparatus with a support member inaccordance with one embodiment of the invention;

FIG. 4 is a functional block diagram of a microprocessor system formingan environment in which one embodiment of the invention may be employed;

FIG. 5 is functional block diagram of a microprocessor system formingthe environment in which one embodiment of the invention may beemployed;

FIG. 6 is a functional block diagram of a microprocessor system formingthe environment in which one embodiment of the invention may beemployed;

FIG. 7 illustrates a system in which one embodiment of the invention maybe employed;

FIG. 8 is a logic flow diagram illustrating the steps utilized toimplement one embodiment of the invention;

FIG. 9 illustrates a sectional view of the electronic scale inaccordance with one embodiment of the invention; and

FIG. 10 illustrates a top plate of the electronic scale in accordancewith one embodiment of the invention.

FIG. 11 illustrates a high-level depiction of a monitoring systemutilizing two-way communication, in accordance with one embodiment ofthe present invention.

FIG. 12 depicts a flow of operation that permits two-way communicationbetween a central computer and a monitoring apparatus.

FIG. 13 depicts another flow of operation that permits two-waycommunication between a central computer and a monitoring apparatus.

FIG. 14 depicts yet another flow of operation that permits two-waycommunication between a central computer and a monitoring apparatus.

FIG. 15 depicts a flow of operation that permits real-time two-waycommunication between a central computer and a monitoring apparatus.

FIG. 16 depicts a scheme of asking customized questions and collectingthe answers thereto.

FIG. 17 illustrates a graphical user interface that may be used inconjunction with software running on a central computer for the purposeof scheduling questions to be uploaded each day to a monitoringapparatus for questioning of a patient.

FIG. 18 illustrates a graphical user interface that may be used inconjunction with software running on a central computer for presenting aset of trending data.

FIG. 19 depicts a collapsible scale with carpet-spike pads, inaccordance with one embodiment of the invention.

FIG. 20 depicts an embodiment of the present invention, in which aphysiological parameter-measuring device is an optional component.

FIG. 21 depicts an embodiment of a system, in which a physiologicalparameter-measuring device is an optional component.

FIG. 22 depicts a memory device programmed with a set of questionhierarchies.

FIG. 23 depicts a particular question hierarchy logical structure,according to one embodiment of the present invention.

FIG. 24 depicts another question hierarchy logical structure, accordingto one embodiment of the present invention.

FIG. 25 depicts another question hierarchy logical structure, accordingto one embodiment of the present invention.

FIG. 26 depicts yet another question hierarchy logical structure,according to one embodiment of the present invention.

FIG. 27 depicts one method of determining whether a patient is in needof medical assistance, based upon the patient's response to questionspresented from a question hierarchy.

FIG. 28 depicts another method of determining whether a patient is inneed of medical assistance, based upon the patient's response toquestions presented from a question hierarchy.

FIG. 29 depicts a questioning scheme according to one embodiment of thepresent invention.

FIG. 30 depicts an exemplary question sequence composed of fourcategories, according to one embodiment of the present invention.

FIG. 31 depicts a questioning scheme influenced by a mode of operation,according to one embodiment of the present invention.

FIG. 32 depicts an example of execution flow for a monitoring unitdesigned for encouraging weight loss or weight management, according toone embodiment of the present invention.

FIG. 33 depicts a program phase screen that permits a user of the remotecomputing system to divide the person's weight loss or weight managementprogram into phases, according to one embodiment of the presentinvention.

FIG. 34 depicts a verification screen that may be executed by the remotecomputing system according to one embodiment of the present invention.

FIG. 35 depicts a set-up screen that may be executed by the remotecomputing system according to one embodiment of the present invention.

FIG. 36 depicts an interactive system of assessment and verification ofan alert generated by a patient monitoring system, according to oneembodiment of the present invention.

FIG. 37 depicts an embodiment of the system of FIG. 36, according to oneembodiment of the present invention.

FIG. 38 depicts an embodiment of a patient monitoring system, accordingto one embodiment of the present invention.

FIG. 39A depicts a Cartesian plane presenting a measured or calculatedparameter that is compared with a threshold.

FIG. 39B depicts a scheme for altering the threshold depicted in FIG.39A, according to one embodiment of the present invention.

FIG. 40A depicts a Cartesian plane the effectiveness of a given questionin predicting the onset of a medically significant event, according toone embodiment of the present invention.

FIG. 40B depicts a scheme for assessing data, such as that expressed inthe chart of FIG. 40A, according to one embodiment of the presentinvention.

FIG. 41 depicts a patient monitoring device that cooperates with animplanted device 4102, according to one embodiment of the presentinvention.

FIG. 42 depicts a simple example of a cardiac rhythm management device.

FIG. 43 depicts a state transition diagram for the generation of ameasurement, according to one embodiment of the present invention.

FIG. 44 depicts a multiuser wellness parameter monitoring systemaccording to a possible embodiment of the present invention.

FIG. 45 depicts a functional block diagram of a microprocessor systemforming an environment in which a possible embodiment of the inventionmay be employed.

FIG. 46 depicts systems and methods for multiuser wellness parametermonitoring according to a possible embodiment of the present invention.

FIG. 47 depicts a physical structure of a monitoring apparatus usable bymultiple users according to a possible embodiment of the presentinvention.

FIG. 48 depicts a physical structure of a monitoring apparatus usable bymultiple users according to a possible embodiment of the presentinvention.

FIG. 49 depicts aspects of a multiuser wellness parameter monitoringsystem according to a possible embodiment of the present invention.

FIG. 50 is a block diagram illustrating an example implementation of apatient monitoring device.

FIG. 51 is a flowchart illustrating an example operation of the examplepatient monitoring device illustrated in FIG. 50.

FIG. 52 is a flowchart illustrating a second example operation of theexample patient monitoring device illustrated in FIG. 50.

FIG. 53 is a flowchart illustrating a third example operation of theexample patient monitoring device illustrated in FIG. 50.

DESCRIPTION

The embodiments of the invention described herein are implemented as amedical apparatus, system and method capable of monitoring wellnessparameters and physiological data of ambulatory patients andtransmitting such parameters and data to a remote location. At theremote location a medical professional caregiver monitors the patient'scondition and provides medical treatment as may be necessary.

The monitoring device incorporates transducing devices for convertingthe desired measured parameters into electrical signals capable of beingprocessed by a local computer or microprocessor system. The deviceinteracts with the ambulatory patient and then, via an electroniccommunication device such as a modem, transmits the measured parametersto a computer located at a remote site. At the remote location thevarious indicia of the ambulatory patient's condition are monitored andanalyzed by the medical professional caregiver. To provide theambulatory patient with an added level of convenience and ease of use,such monitoring device is contained in a single integrated package.Communication is established between the monitoring apparatus and aremote computer via modem and other electronic communication devicesthat are generally well known commercially available products. At theremote location, the caregiver reviews the patient's condition based onthe information communicated (e.g. wellness parameters and physiologicaldata) and provokes medical treatment in accordance with suchinformation.

Referring now to FIG. 1A, as this embodiment of the invention isdescribed herein, an integrated monitoring apparatus is shown generallyat 10. The integrated monitoring apparatus 10 includes an electronicscale 18. The electronic scale 18 further includes a top plate 11 and abase plate 12. The integrated monitoring apparatus 10 further includes ahousing 14 and a support member 16A. The base plate 12 is connected tothe housing 14 through the support member 16A. The housing 14 furtherincludes output device(s) 30 and input device(s) 28. The apparatus 10 isintegrated as a single unit with the support member coupling the baseplate 12 and the housing 14, thus providing a unit in a one-piececonstruction.

It will be appreciated that other physiological transducing devices canbe utilized in addition to the electronic scale 18. For example, bloodpressure measurement apparatus and electrocardiogram (EKG) measurementapparatus can be utilized with the integrated monitoring apparatus 10for recordation and/or transmission of blood pressure and EKGmeasurements to a remote location. It will be appreciated that othermonitoring devices of physiological body functions that provide ananalog or digital electronic output may be utilized with the monitoringapparatus 10.

Referring to FIGS. 1B, 1C, 1D and 1E it will be appreciated that thesupport member 16A (FIG. 1A) can be made adjustable. For example, FIG.1B illustrates an embodiment of the invention utilizing a telescopingsupport member 16B. Likewise, FIG. 1C illustrates an embodiment of theinvention utilizing a folding articulated support member 16C. FIG. 1Dillustrates yet another embodiment of the invention utilizing supportmember 16D that folds at a pivot point 25 located at its base. It willalso be appreciated that other types of articulated and folding supportmembers may be utilized in other embodiments of the invention. Forexample, FIG. 1E illustrates an embodiment of the invention providing asupport member 16E that is removably insert able into a socket 23. Acable 22 is passed through the support member 16E to carry electricalsignals from the electronic scale 18 to the housing 14 for furtherprocessing. A tether 20 is provided to restrain the movement of thesupport member 16E relative to the base plate 12 once it is removed fromthe socket 23.

FIG. 2 illustrates an embodiment of the invention where the supportmember 82 folds about pivot point 84. Folding the integrated monitoringapparatus about pivot point 84 provides a convenient method of shipping,transporting or moving the apparatus in a substantially horizontalorientation. The preferred direction of folding is indicated in thefigure, however, the support member 82 can be made to fold in eitherdirection. Furthermore, an embodiment of the invention provides rubberfeet 85 underneath the base plate 12.

Furthermore, FIG. 3 illustrates one embodiment of the inventionproviding an articulated, folding support member 86. The support member86 folds at two hinged pivot points 88, 90. Also illustrated is asectional view of the scale 18, top plate 11, base plate 12, load cell100 and strain gage 102.

Referring now to FIG. 4, a microprocessor system 24 including a CPU 38,a memory 40, an optional input/output (I/O) controller 42 and a buscontroller 44 is illustrated. It will be appreciated that themicroprocessor system 24 is available in a wide variety ofconfigurations and is based on CPU chips such as the Intel, Motorola orMicrochip PIC family of microprocessors or microcontrollers.

It will be appreciated by those skilled in the art that the monitoringapparatus requires an electrical power source 19 to operate. As such,the monitoring apparatus may be powered by: ordinary household A/C linepower, DC batteries or rechargeable batteries. Power source 19 provideselectrical power to the housing for operating the electronic devices. Apower source for operating the electronic scale 18 is generated withinthe housing, however those skilled in the art will recognize that aseparate power supply may be provided or the power source 19 may beadapted to provide the proper voltage or current for operating theelectronic scale 18.

The housing 14 includes a microprocessor system 24, an electronicreceiver/transmitter communication device such as a modem 36, an inputdevice 28 and an output device 30. The modem 36 is operatively coupledto the microprocessor system 24 via the electronic bus 46, and to aremote computer 32 via a communication network 34 and modem 35. Thecommunication network 34 being any communication network such as thetelephone network, wide area network or Internet. It will be appreciatedthat the modem 36 is a generally well known commercially availableproduct available in a variety of configurations operating at a varietyof BAUD rates. In one embodiment of the invention the modem 36 isasynchronous, operates at 2400 BAUD and is readily availableoff-the-shelf from companies such as Rockwell or Silicon Systems Inc.(SSI).

It will be appreciated that output device(s) 30 may be interfaced withthe microprocessor system 24. These output devices 30 include a visualelectronic display device 31 and/or a synthetic speech device 33.Electronic display devices are well known in the art and are availablein a variety of technologies such as vacuum fluorescent, liquid crystalor Light Emitting Diode (LED). The patient reads alphanumeric data as itscrolls on the electronic display device 31. Output devices 30 include asynthetic speech device 33 such as a Chipcorder manufactured by ISD(part No. 4003). Still, other output devices 30 include pacemaker datainput devices, drug infusion pumps or transformer coupled transmitters.

It will be appreciated that input device(s) 28 may be interfaced withthe microprocessor system 24. In one embodiment of the invention anelectronic keypad 29 is provided for the patient to enter responses intothe monitoring apparatus. Patient data entered through the electronickeypad 29 may be scrolled on the electronic display device 31 or playedback on the synthetic speech device 33.

The microprocessor system 24 is operatively coupled to the modem 36, theinput device(s) 28 and the output device(s) 30. The electronic scale 18is operatively coupled to the microprocessor system 24. Electronicmeasurement signals from the electronic scale 18 are processed by theA/D converter 15. This digitized representation of the measured signalis then interfaced to the CPU 38 via the electronic bus 46 and the buscontroller 44. In one embodiment of the invention, the physiologicaltransducing device includes the electronic scale 18. The electronicscale 18 is generally well known and commercially available. Theelectronic scale 18 may include one or more of the following elements:load cells, pressure transducers, linear variable differentialtransformers (LVDTs), capacitance coupled sensors, strain gages andsemiconductor strain gages. These devices convert the patient's weightinto a useable electronic signal that is representative of the patient'sweight.

In will be appreciated that Analog-to-Digital (A/D) converters are alsogenerally well known and commercially available in a variety ofconfigurations. Furthermore, an A/D converter 15 may be included withinthe physiological transducing device or within the microprocessor system24 or within the housing 14. One skilled in the art would have a varietyof design choices in interfacing a transducing device comprising anelectronic sensor or transducer with the microprocessor system 24.

The scale 18 may provide an analog or digital electronic signal outputdepending on the particular type chosen. If the electronic scale 18provides an analog output signal in response to a weight input, theanalog signal is converted to a digital signal via the A/D converter 15.The digital signal is then interfaced with the electronic bus 46 and theCPU 38. If the electronic scale 18 provides a digital output signal inresponse to a weight input, the digital signal may be interfaced withelectronic bus 46 and the CPU 38.

FIG. 5 illustrates one embodiment of the invention where thecommunication device is a radio frequency (RF) transceiver. Thetransceiver comprises a first radio frequency device 50 including anantenna 52, and a second radio frequency device 54, including an antenna56. The first radio frequency device 52 is operatively coupled to themicroprocessor system 24 via the electronic bus 46, and is in radiocommunication with the second radio frequency device 54. The secondradio frequency device 54 is operatively coupled through amicroprocessor 55 which is operatively coupled to a modem 58. The modem58 is coupled to the communication network 34 and is in communicationwith the remote computer 32 via the modem 35. The first radio frequencydevice 50 and the second radio frequency device 54 are remotely located,one from the other. It will be appreciated that such radio frequencydevices 50, 54 are generally well known and are commercially availableproducts from RF Monolithics Inc. (RFM).

In one embodiment of the invention, such transceivers operate at radiofrequencies in the range of 900-2400 MHz. Information from themicroprocessor system 24 is encoded and modulated by the first RF device50 for subsequent transmission to the second RF device 54, locatedremotely therefrom. The second RF device 54 is coupled to a conventionalmodem 58 via the microprocessor 55. The modem 58 is coupled to thecommunication network 34 via an in-house wiring connection andultimately to the modem 35 coupled to the remote computer 32.Accordingly, information may be transmitted to and from themicroprocessor system 24 via the RF devices 50, 54 via a radio wave orradio frequency link, thus providing added portability and flexibilityto the monitoring apparatus 10. It will be appreciated that variousother communications devices may be utilized such as RS-232 serialcommunication connections, Internet communications connection as well assatellite communication connections. Other communications devices thatoperate by transmitting and receiving infra-red (IR) energy can beutilized to provide a wireless communication link between the patientmonitoring apparatus 10 and a conveniently located network connection.Furthermore, X-10™ type devices can also be used as part of acommunication link between the patient monitoring apparatus 10 and aconvenient network connection in the home. X-10 USA and other companiesmanufacture a variety of devices that transmit/receive data without theneed for any special wiring. The devices works by sending signalsthrough the home's regular electrical wires using what is called powerline carrier (PLC).

Referring now to FIG. 6, one embodiment of the invention wherein adigital electronic scale 21 is provided. Digital weight measurementsfrom the digital electronic scale 21 may be interfaced with themicroprocessor system and CPU 38 without requiring additionalamplification, signal conditioning and A/D converters.

Referring now to FIG. 7, a two way communication system in accordancewith the principals of the present invention is shown. The physiologicaldata of an ambulatory patient is monitored utilizing monitoringapparatus 10 at a local site 58 and is transmitted to a remote computer32 located at a remote computer site 62 via communication network 34. Atthe remote computer site 62 a medical professional caregiver such as anurse, physician or nurse practitioner monitors the patient data andprovokes treatment in accordance with such data.

Operations to perform the preferred embodiment of the invention areshown in FIG. 8. Block 64 illustrates the operation of monitoring ormeasuring the ambulatory patient's physiological parameter. In oneembodiment of the invention, namely for chronic heart failure patients,the physiological parameter monitored is the patient's weight. However,it will be appreciated by those skilled in the art that thephysiological parameters may include blood pressure, EKG, temperature,urine output and any other.

Block 66 illustrates the operation of converting a monitored or measuredphysiological parameter from a mechanical input to an electronic outputby utilizing a transducing device. In one embodiment of the inventionthe transducing device is an electronic scale 18, which converts thepatient's weight into a useable electronic signal.

At block 68, the microprocessor system 24 processes the electronicsignal representative of the transduced physiological parameter. If theresulting parameter value is within certain preprogrammed limits themicroprocessor system 24 initiates communication within the remotecomputer 32 via the communication device 36 over the communicationnetwork 34.

Block 70 illustrates the operation whereby information such as wellnessparameters and physiological data are communicated between themonitoring apparatus 10 and the ambulatory patient. An exemplary list ofthe questions asked to the patient by the monitoring apparatus isprovided in Table 5.

Referring now to FIGS. 7 and 8, upon establishing communication betweenthe local monitoring apparatus 10, at the local site 58, and the remotecomputer 32, at remote site 62, block 72 illustrates the operation ofcommunicating or transmitting processed signals representative ofphysiological data and wellness parameters from the local site 58 to theremote site 62.

FIG. 9 is a sectional view the scale 18 portion of one embodiment of theinvention. The scale 18 comprises a top plate 11 and a base plate 12.The top plate 11 and the base plate 12 having a thickness “T”. A loadcell 100 is disposed between the top plate 11 and the base plate 12 andrests on support/mounting surfaces 96 and 98.

The load cell 100 is a transducer that responds to a forces applied toit. During operation, when a patient steps on the electronic scale 18,the load cell 100 responds to a force “F” transmitted through the topplate 11 and a first support/mounting surface 96. The support/mountingsurface 96 is contact with a first end on a top side of the load cell100. A force “F” that is equal and opposite to “F” is transmitted fromthe surface that the electronic scale 18 is resting on, thorough thebase plate 12 and a second support/mounting surface 98. The secondsupport/mounting surface 98 is in contact with a second end on a bottomside of the load cell 100. In one embodiment, the load cell 100 isattached to the top plate 11 and the base plate 12, respectively, withbolts that engage threaded holes provided in the load cell 100. In oneembodiment the load cell 100 further comprises a strain gage 102.

The strain gage 102 made from ultra-thin heat-treated metallic foils.The strain gage 102 changes electrical resistance when it is stressed,e.g. placed in tension or compression. The strain gage 102 is mounted orcemented to the load cell 100 using generally known techniques in theart, for example with specially formulated adhesives, urethanes, epoxiesor rubber latex. The positioning of the strain gage 102 will generallyhave some measurable effect on overall performance of the load cell 100.Furthermore, it will be appreciated by those skilled in the art thatadditional reference strain gages may be disposed on the load cell wherethey will not be subjected to stresses or loads for purposes oftemperature compensating the strain gage 102 under load. Duringoperation over varying ambient temperatures, signals from the referencestrain gages may be added or subtracted to the measurement signal of thestrain gage 102 under load to compensate for any adverse effects ofambient temperature on the accuracy of the strain gage 102.

The forces, “F” and “F”, apply stress to the surface on which the straingage 102 is attached. The weight of the patient applies a load on thetop plate 11. Under the load the strain gage(s) 102 mounted to the topof the load cell 100 will be in tension/compression as the load cellbends. As the strain gage 102 is stretched or compressed its resistancechanges proportionally to the applied load. The strain gage 102 iselectrically connected such that when an input voltage or current isapplied to the strain gage 102, an output current or voltage signal isgenerated which is proportional to the force applied to the load cell100. This output signal is then converted to a digital signal by A/Dconverter 15.

The design of the load cell 100 having a first end on a top sideattached to the top plate 11 and a second end on a bottom side attachedto the base plate 12 provides a structure for stressing the strain gage102 in a repeatable manner. The structure enables a more accurate andrepeatable weight measurement. This weight measurement is repeatablewhether the scale 18 rests on a rigid tile floor or on a carpeted floor.FIG. 10 illustrates one embodiment of the top plate 11 that providesfour mounting holes 106 for attaching the base plate 12 to one end ofthe load cell 100. The base plate 12 provides similar holes forattaching to the other end of the load cell 100. The top plate 11 andthe base plate 12 (not shown) each comprise a plurality of stiffeningribs 108 that add strength and rigidity to the electronic scale 18.

Table 1 shows multiple comparative weight measurements taken with theelectronic scale 18 resting on a tile floor and a carpeted floor withoutrubber feet on the scale 18. The measurements were taken using the sameload cell 100. The thickness “T” of the top plate 11 and supporting ribswas 0.125″ except around the load cell, where the thickness of thesupporting ribs was 0.250″. The thickness of the load cell 100support/mounting surfaces 96, 98 (FIG. 9) was 0.375″. As indicated inTable 1, with the scale 18 resting on a tile floor, the average measuredweight was 146.77 lbs., with a standard deviation of 0.11595.Subsequently, with the scale 18 resting on a 0.5″ carpet with 0.38″ padunderneath and an additional 0.5″ rug on top of the carpet, the averagemeasured weight was 146.72 lbs., with a standard deviation of 0.16866.

TABLE 1 Thick Scale Parts Around Load Cell 0.250″ TILE (lbs.) CARPET(lbs.) 146.9 146.7 146.7 147 146.9 146.6 146.8 146.7 146.6 146.6 146.8147 146.8 146.5 146.7 146.6 146.9 146.8 146.6 146.7 0.11595 (stddev)0.16866 (stddev) 146.77 (average) 146.72 (average)

Table 2 shows multiple weight measurements taken with the scale 18 on atile floor and a carpeted floor with rubber feet on the bottom of thescale 18. The measurements were taken using the same load cell 100. Thethickness “T” of the top plate 11 was 0.125″ including the thicknessaround the load cell. As indicated in Table 2, with the scale 18 restingon a tile floor on rubber feet, the average measured weight was 146.62lbs., with a standard deviation of 0.07888. Subsequently, with the scale18 resting on a 0.5″ carpet with 0.38″ pad underneath and an additional0.5″ rug on top of the carpet, the average measured weight was 146.62lbs., with a standard deviation of 0.04216.

TABLE 2 Thin Scale Parts Throughout 0.125″ TILE (lbs.) CARPET (lbs.)146.7 146.7 146.7 146.7 146.6 146.6 146.6 146.6 146.6 146.6 146.6 146.6146.5 146.6 146.7 146.6 146.5 146.6 146.7 146.6 0.07888 (stddev) 0.04216(stddev) 146.62 (average) 146.62 (average)

Table 3 shows multiple weight measurements taken with an off-the-shelfconventional electronic scale. As indicated in table 3, with theoff-the-shelf conventional scale resting on the tile floor, the averagemeasured weight was 165.5571 lbs., with a standard deviation of 0.20702.Subsequently, with the off-the-shelf conventional scale resting on a0.5″ carpet with 0.38″ pad underneath and an additional 0.5″ rug on topof the carpet, the average measured weight was 163.5143 lbs., with astandard deviation of 0.13093.

TABLE 3 Off-The-Shelf Conventional Scale TILE (lbs.) CARPET (lbs.) 165.9163.5 165.5 163.4 165.8 163.7 165.4 163.6 165.5 163.6 165.4 163.5 165.4163.3 — 163.4 0.20702 (stddev) 0.13093 (stddev) 165.5571 (average)163.5143 (average) 2.042857 (% of difference) 1.249345 (% of difference)

The summary in Table 4 is a comparative illustration of the relativerepeatability of each scale while resting either on a tile floor or on acarpeted floor.

TABLE 4 SUMMARY OF DATA: TILE VS. TRIAL TILE STDDEV CARPET STDDEV CARPETHeavy Scale Parts All 0.125″ Except Cell Around the Load Cell 0.250″ 1146.77 0.1159 146.72 0.1686 0.05 2 146.67 0.0823 146.72 0.1906 0.05 ThinScale Parts All 0.125″ 1 146.62 0.0788 146.62 0.04216 0.00 Off-The-ShelfConventional Scale 1 165.55 0.207 163.51 0.1309 2.04

The foregoing description was intended to provide a general descriptionof the overall structure of several embodiments of the invention, alongwith a brief discussion of the specific components of these embodimentsof the invention. In operating the apparatus 10, an ambulatory patientutilizes the monitoring apparatus 10 to obtain a measurement of aparticular physiological parameter. For example, an ambulatory patientsuffering from chronic heart failure will generally be required tomonitor his or her weight as part of in-home patient managing system.Accordingly, the patient measures his or her weight by stepping onto theelectronic scale 18, integrally located within the base plate 12 of themonitoring apparatus 10.

Referring now to FIG. 4, the modem 36 of the monitoring apparatus 10will only activate if the measured weight is within a defined range suchas +/−10 lbs, +/−10% or any selected predetermined value of a previousweight measurement. The patient's previous symptom free weight (dryweight) is stored in the memory 40. The dry weight is the patient'sweight whenever diuretics are properly adjusted for the patient, forexample. This prevents false activation of the modem 36 if a child, pet,or other person accidentally steps onto the electronic scale 18.

Upon measuring the weight, the microprocessor system 24 determineswhether it is within a defined, required range such as +/−10 lbs. or+/−10% of a previously recorded weight stored in memory 40. Themonitoring apparatus 10 then initiates a call via the modem 36 to theremote site 62. Communications is established between the localmonitoring apparatus 10 and the remote computer 32. In one embodiment ofthe invention, the patient's weight is electronically transferred fromthe monitoring apparatus 10 at the local site 58 to the remote computer32 at the remote site 62. At the remote site 62 the computer programcompares the patient's weight with the dry weight and wellnessinformation and updates various user screens. The program can alsoanalyze the patient's weight trend over the previous 1-21 days. Ifsignificant symptoms and/or excessive weight changes are reported, thesystem alerts the medical care provider who may provoke a change to thepatient's medication dosage, or establish further communication with thepatient such as placing a telephone to the patient. The communicationbetween the patient's location and the remote location may be one way ortwo way communication depending on the particular situation.

1To establish the patient's overall condition, the patient is promptedvia the output device(s) 30 to answer questions regarding variouswellness parameters. An exemplary list of questions, symptoms monitoredand the related numerical score is provided in Table 5 as follows:

TABLE 5 Health Check Score Question Symptom Value Above Dry Weight?Fluid accumulation 10 Are you feeling short of breath? Dyspnea 10 Didyou awaken during the night Paroxysmal nocturnal 5 short of breath?dyspnea Did you need extra pillows last night? Congestion in the lungs 5Are you coughing more than usual? Congestion in the lungs 3 Are yourankles or feet swollen? Pedal edema 5 Does your stomach feel bloated?Stomach edema 3 Do you feel dizzy or lightheaded? Hypotension 5 Are youmore tired than usual? Fatigue 2 Are you taking your medication?Medication compliance 7 Has your appetite decreased? Appetite 2 Are youreducing your salt intake? Sodium intake 1 Did you exercise today?Fitness 1

1At the remote site 62 the medical professional caregiver evaluates theoverall score according to the wellness parameter interrogationresponses (as shown in Table 5). For example, if the patient's totalscore is equal to or greater than 10, an exception is issued and willeither prompt an intervention by the medical professional caregiver inadministering medication, or prompt taking further action in the medicalcare of the patient.

1The output device(s) 30 varies based on the embodiment of theinvention. For example, the output device may be a synthetic speechdevice 33. As such, the wellness parameters are communicated to thepatient via the electronic synthetic speech device 33 in the form ofaudible speech. It will be appreciated that electronic speechsynthesizers are generally well known and widely available. The speechsynthesizer converts electronic data to an understandable audiblespeech. Accordingly, the patient responds by entering either “YES” or“NO” responses into the input device 28, which may include for example,an electronic keypad 29. However, in one embodiment of the invention,the input device may also include a generic speech recognition devicesuch as those made by International Business Machines (IBM), DragonSystems, Inc. and other providers. Accordingly, the patient replies tothe interrogations merely by speaking either “YES” or “NO” responsesinto the speech recognition input device.

1In embodiments of the invention that include electronic display device31 as an output device 30, the interrogations as well as the responsesare displayed and/or scrolled across the display for the patient toread. Generally, the electronic display will be positioned such that itis viewable by the patient during the information exchanging processbetween the patient and the remote computer 32.

1Upon uploading the information to the remote computer 32, the medicalprofessional caregiver may telephone the patient to discuss, clarify orvalidate any particular wellness parameter or physiological data point.Furthermore, the medical professional caregiver may update the list ofwellness parameter questions listed in Table 5 from the remote site 62over the two way communication network 34. Modifications are transmittedfrom the remote computer 32 via modem 35, over the communication network34, through modem 36 and to the monitoring apparatus 10. The modifiedquery list is then stored in the memory 40 of the microprocessor system24.

Two-Way Communication

1FIG. 11 is presented in furtherance of the previous discussionregarding two-way communication between the patient monitoring apparatusand the central computer. FIG. 11 is a high-level depiction of themonitoring system, and may be used as a starting point for a moredetailed discussion of the two-way communication schemes.

1As can be seen from FIG. 11, the system comprises a patient monitoringapparatus 1100 and a central computer 1102. The central computer 1102 ishoused within a facility 1104 that is located remote from the patientmonitoring apparatus 1100. For example, the patient monitoring apparatus1100 may be located in the home of an ambulatory patient 1105, while thecentral computer 1102 is located in a cardiac care facility 1104.

1As described previously, the patient monitoring apparatus 1100 iscomposed of a central processor unit 1106, which is in communicationwith an input device 1108, an output device 1110, and a sensor 1112. Asalso previously described the sensor 1112 may be a transducer used toconvert a physiological measurement into a signal, such as an electricalsignal or an optical signal. For example, the sensor 1112 may comprise aload cell configured with a strain gauge, arranged to determine thepatient's 1105 weight; the sensor 1112 would represent the patient's1105 weight as an electrical signal.

1As discussed previously, the output device 1110 may be used to promptthe patient 1105 with questions regarding the patient's wellness. Theoutput device 1110 may consist of a visual display unit that displaysthe questions in a language of the patient's 1105 choosing.Alternatively, the output device 1110 may consist of an audio outputunit that vocalizes the questions. In one embodiment, the audio outputunit 1110 may vocalize the questions in a language of the patient's 1105choosing.

1As discussed previously, the input device 1108 may be used to receivethe patient's 1105 response to the questions posed to him/her 1105. Theinput device 1108 may consist of a keyboard/keypad, a set of buttons(such as a “yes” button and a “no” button), a touch-screen, a mouse, avoice digitization package, or a voice recognition package.

The patient monitoring apparatus 1100 communicates with the centralcomputer 1102 via a network 1118; the patient monitoring apparatus 1100uses a communication device 1114 to modulate/demodulate a carrier signalfor transmission via the network 1118, while the central computer uses acommunication device 1116 for the same purpose. Examples of suitablecommunication devices 1114 and 1116 include internal and external modemsfor transmission over a telephone network, network cards (such as anEthernet card) for transmission over a local area network, a networkcard coupled to some form of modem (such as a DSL modem or a cablemodem) for transmission over a wide area network (such as the Internet),or an RF transmitter for transmission to a wireless network.Communication may occur over a television network, such as a cable-basednetwork or a satellite network, or via an Internet network.

A system composed as described above may be programmed to permit two-waycommunication between the central computer 1102 and the patientmonitoring apparatus 1100.

Two-way communication may permit the central computer 1102 to upload acustomized set of questions or messages for presentation to a patient1105 via the monitoring apparatus 1100. For example, in the case wherethe monitoring apparatus 1100 monitors the patient's 1105 weight, asudden increase in weight following a high sodium meal might cause thehealth care provider to send a customized question for presentation tothe patient 1105: “Did consume any salty food in the last 24 hours?”Such a customized question could be presented to the patient 1105 thenext time the patient uses the monitoring apparatus 1100 or could bepresented to the patient in real time (these options are discussed ingreater detail, below). Additionally, a customized message may bescheduled for delivery at certain times (such as every Friday of theweek—this is also discussed in greater detail, below). Further, thesecustomized messages may be entered on the fly or selected from a list(this is also discussed in greater detail below).

FIG. 12 depicts a flow of operations that permits two-way communicationbetween the central computer 1102 and the monitoring apparatus 1100.FIG. 12 presents a flow of interactions between the central computer1102 and the monitoring apparatus 1100 on a first day (operation1200-1210) and on a second day (1212-1222). In the discussion thatfollows, it will be assumed that the monitoring apparatus 1100 is formedas a scale that monitors a patient's weight, although this need not bethe case. It is further assumed that the patient 1105 measures his/herweight on a daily basis (although, in principle, any frequency ofmeasurement would operate within the bounds of this embodiment), afterwhich a communication session is initiated between the central computer1102 and the monitoring apparatus 1100.

On the first day, operation begins with the patient 1105 stepping on thescale, as shown in operation 1200; the patient's 1105 weight ismeasured, transduced, and stored by the central processing unit 1106.Next, in operation 1202, a memory device is accessed by the centralprocessing unit 1106 for the purpose of retrieving a set of customizedquestions downloaded during the previous day. Each question is asked, ina one-by-one fashion, and a corresponding answer received from thepatient 1105 via the input device 1108 is recorded (if the customizedprompt is merely a statement, the statement is output to the patient andno answer is requested of the patient 1105). Next, in operation 1204, acommunication session is initiated. The session may be initiatedmanually (for example, by the patient pushing a button); the session maybe initiated automatically by the scale at a specific time of the day(such as at midnight, after the patient 1105 is assumed to have weightedhimself/herself and recorded his/her answers to the customized wellnessquestions); the session may be initiated automatically by the scale uponthe patient 1105 answering the final question; finally, the session maybe initiated by the central computer 1102 at a specific time of the day(such as at midnight, after the patient 1105 is assumed to have weightedhim/herself and recorded his/her answers to the customized wellnessquestions). During the communication session, customized questions to beasked to the patient 1105 the next day are downloaded by the monitoringapparatus 1100, as depicted in operation 1206. Additionally, the answersrecorded in operation 1202 are uploaded to the central computer 1102, asdepicted in operation 1208. Finally, in operation 1210, thecommunication session is terminated.

On the second day, the same set of operations takes place, withreferences to previous and future days now referring to “DAY 1” and “DAY3,” respectively: in operation 1214, the set of questions downloadedduring the first day (in operation 1206) are asked, and the answers arerecorded; similarly, in operation 1218, a set of customized questions tobe asked on a third day are uploaded to the monitoring apparatus 1100.

Downloading operations (such as operations 1206 and 1218) and uploadingoperations (such as operation 1208 and 1220) may be influenced by theform of input device 1108 or output device 1110 chosen for use by themonitoring apparatus 1100. For example, if the output device 1110 is avisual display, then a set of data representing the text of the questionis transmitted to the monitoring apparatus 1100 during the downloadingoperations 1206 and 1208. If, however, the output device 1110 is anaudio output device, then a set of data representing a vocalization ofthe question may be transmitted to the monitoring apparatus 1100 duringthe downloading operations 1206 and 1208. In any case, the data beingtransmitted to the monitoring apparatus 1100 may be compressed for thesake of preservation of bandwidth. Similar considerations apply to theuploading operations 1208 and 1220, based upon the choice of inputdevice 1108. If the input device 1108 is a set of buttons (for example,a “yes” button and a “no” button), then the data uploaded to the centralcomputer 1102 is representative of the button that was pushed. If theinput device 1108 is a voice digitization package, then the datauploaded to the central computer 1102 is representative of the digitizedvoice pattern from the patient 1105. As in the case of the downloadingoperations, the data being uploaded to the central computer 1102 may becompressed for the sake of preservation of bandwidth.

FIGS. 13, 14, and 15 depict other flows of operation for two-waycommunication between a central computer 1102 and a patient monitoringapparatus 1100. The considerations regarding the format of the databeing uploaded and downloaded also apply to the schemes illustratedtherein.

FIG. 13 depicts a flow of operations that permits two-way communicationbetween the central computer 1102 and the monitoring apparatus 1100.FIG. 13 presents a flow of interactions between the central computer1102 and the monitoring apparatus 1100 on a first day (operation1300-1314) and on a second day (1316-1328). In the discussion thatfollows, it will be assumed that the monitoring apparatus 1100 is formedas a scale that monitors a patient's weight, although this need not bethe case. It is further assumed that the patient 1105 measures his/herweight on a daily basis (although, in principle, any frequency ofmeasurement would operate within the bounds of this embodiment).

On the first day, operation begins with a communication session betweenthe central computer 1102 and the monitoring apparatus 1100 beinginitiated, as shown in operation 1300. During this communicationsession, a set of customized questions to be asked to the patient 1105later in the day are downloaded by the monitoring apparatus 1100, asdepicted in operation 1302. Then, in operation 1304, the communicationsession is terminated. The communication session initiated in operation1300 may be initiated by the monitoring apparatus. Additionally, thesession may be initiated at a time of the day that justifies theassumption that any new customized questions would have already beenentered for downloading by the monitoring device 1100. At some point inthe day after the termination of the communication session, the patient1105 weighs himself on the monitoring apparatus, as shown in operation1306, and the weight is stored by the central processing unit 1106.Next, in operation 1308, a memory device is accessed by the centralprocessing unit 1106 for the purpose of retrieving the set of customizedquestions downloaded earlier in the day during operation 1302. Eachquestion is asked, in a one-by-one fashion, and a corresponding answerreceived from the patient 1105 via the input device 1108 is recorded.Next, in operation 1310, a communication session is initiated. As in thescheme depicted in FIG. 12, the session may be initiated manually orautomatically. During this session, the answers recorded in operation1308 are uploaded to the central computer 1102, as depicted in operation1312. Finally, in operation 1314, the communication session isterminated.

As can be seen from FIG. 13, the set of operations performed on thesecond day (operations 1316-1328) are identical to the operationsperformed on the first day (operations 1300-1314).

FIG. 14 depicts another flow of operations that permits two-waycommunication between the central computer 1102 and the monitoringapparatus 1100. The flow of operations depicted in FIG. 14 is the sameas that which is shown in FIG. 13, with minor exceptions. The flowdepicted in FIG. 14 is arranged such that the central computer 1102initiates the first communication session (in operation 1400), duringwhich a set of customized questions are downloaded by the monitoringdevice; however, later in the day, the monitoring device 1100 initiatesthe second communication session (in operation 1410), during which thepatient's 1105 weight and answers to the customized questions aretransmitted to the central computer 1102. This scheme has the advantageof allowing the central computer 1102 to initiate the session duringwhich the customized questions are uploaded to the monitoring apparatus1100, thereby ensuring that the communication session occurs after thenew questions have been entered by the health care provider (if themonitoring apparatus 1100 initiates the communication session, as inFIG. 13, the session may be initiated before the new questions areentered). Just as in the scheme depicted in FIG. 13, the scheme depictedin FIG. 14 employs the same set of operations from day to day.

FIG. 15 depicts a flow of operations that permits real-time two-waycommunication between the central computer 1102 and the monitoringapparatus 1100. In the discussion that follows, it will be assumed thatthe monitoring apparatus 1100 is formed as a scale that monitors apatient's weight, although this need not be the case. It is furtherassumed that the patient is free to weight himself/herself at any timeduring the day and that the measured weight will be stored. The schemedepicted in FIG. 15 permits the patient 1105 to initiate a communicationsession, during which the health care provider may, via the centralcomputer, enter questions that are posed to the patient in real-time viathe monitoring apparatus 1100. The communication session does not enduntil the health care provider indicates that it has no furtherquestions to ask the patient. Thus, the health care provider may adaptits questions in real-time, based upon the answers received from thepatient 1105.

Operation begins with a communication session between the centralcomputer 1102 and the monitoring apparatus 1100 being initiated, asshown in operation 1500. Next, in operation 1502, the central computer1102 generates a visual cue on its graphical user interface to indicatethat a particular patient is logged in. A health care provider/operatorat the central computer 1102 is thereby made aware of his/heropportunity to prompt the patient 1105 with customized questions inreal-time. Subsequently, in operation 1504, the weight of the patient1105 is uploaded to the central computer. As mentioned earlier, thepatient 1105 is assumed to have weighed himself/herself at a point inthe day prior to the initiation of the communication session inoperation 1500. This permits the patient 1105 to consistently measurehis/her weight at a given point in the day (perhaps immediately uponwaking in the morning), yet answer questions regarding his/her symptomsat a point later in the day, so that the patient 1105 has had a chanceto judge his/her general feeling of health/illness before answering thequestions. Of course, this is an optional feature of the invention andis not crucial. In operation 1506, a first customized question isuploaded to the monitoring apparatus. During operation 1506, a healthcare provider/operator may enter a question to be posed to the patient1105; it is immediately transmitted to the monitoring apparatus 1100 andposed to the patient 1105. In operation 1508, the patient's answer istransmitted to the central computer 1102. Next, in operation 1510, theoperator/health care provider at the central computer 1102 indicateswhether or not any additional questions are pending. If so, control ispassed to operation 1506, and the additional questions are asked andanswered. Otherwise, the communication session is terminated inoperation 1512.

Scheduling of Questions and Presentation of Trending Data

FIG. 16 illustrates a scheme of asking customized questions andcollecting the answers thereto. As can be seen from FIG. 16, a set ofcustomized questions may be downloaded to a monitoring device 1100 onDAY N. The customized questions will be asked to the patient 1105, andthe answers recorded either later in the day on DAY N or on DAY N+1(depending upon the particular 2-way scheme employed). The answers tothe customized questions are retrieved by the central computer 1102 onDAY N+1. The particular questions asked from day-to-day may vary, basedupon instruction from the health care provider.

FIG. 17 illustrates a graphical user interface that may be used inconjunction with software running on the central computer 1102 for thepurpose of scheduling the questions to be uploaded each day to themonitoring apparatus 1100 (as illustrated by FIG. 16) for questioning ofthe patient 1105. As can be seen from FIG. 17, a message field 1700 isprovided that permits an operator/health care provider to enter acustomized message to be uploaded to the monitoring apparatus 1100. Astart-date field 1702 and an end-date field 1704 define the periodduring which the questions are to be asked; a frequency field indicates1706 the frequency with which the question entered in field 1700 is tobe asked. For example, if the message field 1700 contained the question“Did you remember to take your medication this week?”, the start-datefield 1702 contained “Aug. 1, 2001,” the end-date field 1704 contained“Sep. 1, 2001,” and the frequency field 1706 contained “Friday,” thenthe patient 1105 would be prompted with the question “Did you rememberto take your medication this week?” on each Friday between Aug. 1, 2001and Sep. 1, 2001. An alert field 1708 permits an operator/health careprovider to define an answer that, when provided by patient 1105, sendsan alert to the health care provider. For example, in the case where thequestion was “Did you remember to take your medication this week?”, thealert field 1708 may contain the answer “No,” so that the health careprovider would be alerted if the patient 1105 indicated that he/she hadfailed to take his/her medication during the week.

The data entered via the graphical user interface depicted in FIG. 17 isstored in a database. The data may be organized based upon dates fortransmission to the monitoring device 1100, so that all of the questionsto be uploaded to the monitoring device 1100 on a given day may beeasily acquired. The data may be sorted other ways, as well. Forexample, the data may be sorted based upon which questions were asked onwhich days, so that a presentation of the questions posed to a patienton a given day (or set of days) and the corresponding answers theretomay be easily developed. A graphical user interface that provides such apresentation is depicted in FIG. 18.

FIG. 18 depicts a graphical user interface that presents all of thecustomized questions presented to a patient over a particular durationand all of the corresponding answers for each day. This sort ofinformation is referred to as “trending data,” because it permits ahealth care provider to quickly determine if a particular symptom beganregularly exhibiting itself on a certain day, or if a particular symptomis randomly exhibited. As can be seen from FIG. 18, a message field 1800is provided which presents a customized question that was asked duringthe timeframe indicated by the date bar 1801. Under each date presentedin the date bar 1801 is an answer field 1802-1816, which presents thepatient's 1105 answer to the question presented in the message field1800. If a particular question was not asked on a given day, thegraphical user interface may so indicate. For example, an answer field1802-1816 may be grayed out on a particular day if the question was notasked, or an answer field may be highlighted on days in which theparticular question was asked. As described earlier, the data used topopulate fields 1800-1816 is retrieved from a database containing eachof the questions asked on a given day and each of the correspondinganswers.

Other reporting schemes and graphical user interfaces are taught in U.S.application Ser. No. 09/399,041 filed on Sep. 21, 1999, entitled“MEDICAL WELLNESS PARAMETERS MANAGEMENT SYSTEM, APPARATUS AND METHOD,”which is hereby incorporated by reference in its entirety.

Collapsible Scale/Carpet-Spike Pads

FIG. 19 depicts a collapsible scale 1900 with integrated carpet-spikepads, in accordance with one embodiment of the present invention. As canbe seen from FIG. 19, a collapsible scale 1900 is comprised of a base1902, upon which a patient 1105 stands in order to weighhimself/herself. Perpendicular to the base 1902 is a support member 1904which elevates a housing 1906 at about waist level. The housing 1906 maycontain an input device, an output device, a processor, and acommunication device. The support member 1904 is coupled to the base1902 via a hinge 1914. The hinge 1914 enables the support member 1904 tofold into a position approximately parallel (though not necessarilycoplanar) with the base 1902, thereby permitting the scale 1900 to fiteasily (and in one piece) into a box suitable for shipping. Anotheradvantage of the collapsible embodiment is that it relieves the patient1105 of having to assemble the scale at his/her home.

The base 1902 may be composed of top plate 1908, upon which the patient1105 stands, and a base plate 1910. The hinge 1914 may be coupled to thesupport member 1904 and the top plate 1908, so that if the patient leansupon the housing 1906, the force is conducted down the support member1904, though the hinge 1914, and to the top plate 1908, therebypreserving the validity of the weight measurement. Alternatively, thetop plate 1908 may have member 1912 rigidly coupled thereto. In such acase, the hinge 1914 may be coupled between the support member 1904 andthe rigidly coupled member 1912.

In one embodiment of the scale 1900, a plurality of carpet-spike pads1916 are attached to the bottom of the base 1902. A carpet-spike pad1926 is a disk with a plurality of spikes that protrude downwardlytherefrom. The carpet-spike pads 1916 improve the stability of the scale1900 upon carpet-like surfaces, thereby enhancing the accuracy andrepeatability of measurements taken therewith. The carpet-spike pads1916 may be attached to the base 1902 by an adhesive, by force fit, ormay be integrated into the base 1902 itself.

Question Hierarchies

FIG. 20 depicts an embodiment of the patient monitoring apparatus 2000,in which the housing 2002, the output device 2004, and the input device2006 stand alone as a complete unit. (A physiologicalparameter-measuring unit, such as a scale, is not required to interfacewith the unit 2000, but may be added). As in other embodiments,circuitry for operation of the device is held within the housing 2000.The output device 2002 may be a display, such as an LCD screen, and mayinclude an audio output unit. The input device 2006 is depicted as twobuttons, a “YES” button and a “NO” button. One skilled in the artunderstands that the input device may be a keypad, a mouse, a button, aswitch, a light pen, or any other suitable input device. In oneembodiment of the invention, the input and output devices 2004 and 2006are combined into a touch-screen device.

The patient monitoring apparatus 2000 of FIG. 20 may be programmed tocontain a plurality of question hierarchies, each of which relates to ahealth-related symptom. Each hierarchy contains a set of questions. Eachquestion in a given hierarchy is aimed at characterizing a particularsymptom in a particular way. Certain questions within a hierarchy may bedeemed moot (and thus will not be asked) in light of a patient's answerto a previous question. Details regarding question hierarchies will bediscussed in greater detail, below.

By programming the patient monitoring apparatus 2000 to contain aplurality of question hierarchies, the unit 2000 attains greatflexibility as a tool for monitoring chronic diseases of many varieties.A particular chronic disease may be monitored by asking questions aboutsymptoms associated with the disease. Thus, for example, the unit 2000may be made to monitor the health status of a patient with chronicobstructive pulmonary disease (COPD) by querying the patient, usingquestions extracted from question hierarchies relating to symptomsassociated with COPD. The same unit 2000 may be used to monitor apatient with diabetes by asking questions extracted from a different setof question hierarchies, which are related to symptoms associated withdiabetes.

FIG. 21 is a high-level depiction of a monitoring system employing theembodiment 2000 depicted in FIG. 20, and may be used as a starting pointfor a more detailed discussion of the patient monitoring apparatus 2000.

As can be seen from FIG. 21, the system comprises a patient monitoringapparatus 2000 and a central computer 2100. The central computer 2100 ishoused within a facility 2102 that is located remote from the patientmonitoring apparatus 2000. For example, the patient monitoring apparatus2000 may be located in the home of an ambulatory patient 2104, while thecentral computer 2100 is located in a health care facility 2102.

As described previously, the patient monitoring apparatus 2000 iscomposed of a central processor unit 2106, which is in communicationwith an input device 2006, an output device 2004, and a memory device2108. The memory device 2108 has a plurality of question hierarchiesstored within it, as discussed more fully, below.

As discussed previously, the output device 2004 may be used to promptthe patient 2104 with questions regarding the patient's wellness. Theoutput device 2004 may consist of a visual display unit that displaysthe questions in a language of the patient's 2104 choosing.Alternatively, the output device 2004 may consist of an audio outputunit that vocalizes the questions. In one embodiment, the audio outputunit 2004 may vocalize the questions in a language of the patient's 2104choosing.

The patient monitoring apparatus 2000 communicates with the centralcomputer 2100 via a network 2110; the patient monitoring apparatus 2000uses a communication device 2112 to modulate/demodulate a carrier signalfor transmission via the network 2110, while the central computer uses acommunication device 2114 for the same purpose. Examples of suitablecommunication devices 2112 and 2114 include internal and external modemsfor transmission over a telephone network, network cards (such as anEthernet card) for transmission over a local area network, a networkcard coupled to some form of modem (such as a DSL modem or a cablemodem) for transmission over a wide area network (such as the Internet),or an RF transmitter for transmission to a wireless network.

A system composed as described above may be programmed to carry onperiodic (e.g., daily) questioning of a patient 2104, with respect tothe patient's 2104 perception regarding his or her own status vis-à-visa particular set of symptoms. For example, a patient suffering from COPDis likely to experience shortness of breath, both during the day andduring the night (amongst many other symptoms). Thus, the system mayquestion the patient 2104 about his own perceptions regarding hisshortness of breath. The questions used to determine the patient's 2104judgment about his own shortness of breath during the day are containedin a first question hierarchy. Similarly, questions related to thepatient's 2104 shortness of breath during the night are contained in asecond question hierarchy.

The first hierarchy, which is related to shortness of breath during theday, may be structured as follows:

TABLE 5 Question Hierarchy: Shortness of Breath During the Day Question#1 Are you feeling more short of breath? Question #2 Do you feel moreshort of breath in response to physical exertion? Question #3 Do youfeel more short of breath during periods of rest? Question #4 Doesstress make you feel more short of breath?

Each of the questions in the hierarchy is related to day-time shortnessof breath. The first question is broadly focused, simply asking “Are youfeeling more short of breath?” Clearly, if the patient 2104 were toanswer “no” to such a question, the remainder of the questions would beunnecessary. Thus, the system may be designed to prevent the remainingquestions from being asked (this will be discussed in greater detail,below). Question #2 asks a question that is more particularized thanquestion #1: “Do you feel more short of breath in response to physicalexertion?” An affirmative answer to this question is more serious, andprovides more particularized information, than an affirmative answer tothe broader query presented in question #1. Although not essential, eachquestion hierarchy may be constructed in accordance with this paradigm:(1) a negative answer to a preceding question negates the need to askany additional questions in the hierarchy; (2) successive questionsrelate to increasingly more particularized aspects of a given symptom;and (3) successive questions relate to an increasing severity level of agiven symptom.

FIG. 22 depicts the partial contents of the memory device 2108 of FIG.21. As can be seen from FIG. 21, the memory device 2108 is programmedwith a set of question hierarchies 2200. In the example depicted in FIG.22, the memory device is programmed with six question hierarchies 2201,2202, 2203, 2204, 2205, and 2206 (collectively referred to as “the setof question hierarchies 2200”). As described previously, each hierarchyrelates to a symptom condition to be monitored, meaning that the numberof question hierarchies stored in the memory device 2108 is dependentupon the number of symptoms to be monitored.

Hierarchy 2201 has a basic structure that includes a first question Q1,followed by a first decision point D1. At decision point D1, the patientmonitoring apparatus 2000 decides whether or not to ask the subsequentquestion, Q2. For example, Q1 may be a question that reads “Are youfeeling more short of breath?” If the patient 2104 answers “no,” thisanswer is analyzed at decision point D1, and the questioning terminatesat terminal point T1. Otherwise, the questioning continues with the nextquestion, Q2, and the process continues.

Each of the hierarchies 2200 depicted in FIG. 22 possesses theabove-recited structure, although other structures are possible, some ofwhich are described below. One skilled in the art understands thatalthough each hierarchy 2200 is depicted as consisting of threequestions, a hierarchy may consist of any number of questions, includinga single question.

As depicted in FIG. 22, the memory device 2108 is in data communicationwith the monitoring device's 2000 microprocessor 2106, which, in turn,is in data communication with a remote computer 2100 (not depicted inFIG. 22) via a network 2110 and via a communication device 2112 (alsonot depicted in FIG. 22). The remote computer 2100 transmits a symptomidentifier 2208 to the monitoring device's 2000 microprocessor 2106. Thesymptom identifier 2208 corresponds to a question hierarchy 2200. Forexample, a symptom identifier with a value of “1” may correspond tohierarchy 2201, while a symptom identifier with a value of “2”corresponds to hierarchy 2202, etc. The microprocessor 2106 responds tohaving received a symptom identifier 2202 by executing the correspondinghierarchy (i.e., asking a question within the hierarchy, and decidingwhether or not to ask a subsequent question therein). Thus, the patientmonitoring device 2200 may be made to execute n number of questionhierarchies by transmitting to it n number of symptom identifiers.

Given that a known set of symptoms are correlated with any given chronicdisease, the patient monitoring device 2000 may be tailored to monitorthe health status of a patient 2104 with a particular disease byexecuting question hierarchies 2200 relating to symptoms correspondingwith the patient's 2104 particular disease. Thus, the remote computer2100 may be programmed with software that presents a menu for eachpatient 2104. The menu allows the health care provider to select fromamong a set of chronic diseases. Based upon the selected chronicdisease, the remote computer 2100 transmits one or more symptomidentifiers (which correspond to symptoms known to accompany theselected disease) to the patient monitoring apparatus 2000. The remotecomputer 2100 receives the patient's 2104 responses, and scores theresponse in accordance with a scoring algorithm, discussed in detailbelow. Based upon the outcome of the score, an exception report may begenerated, meaning that a health care provider will be notified of thepatient's possible need for assistance. Alternatively, the remotecomputer 2100 may be programmed to transmit an e-mail message or anumeric page to communicate the information concerning the patient 2104.In principle, any data transmission communicating the patient's 2104potential need for assistance may be transmitted.

In certain situations, it may be desirable for the patient monitoringdevice 2000 to obtain information regarding a physiological parameter.For example, if a particular chronic disease is associated with a fever,the patient monitoring device may want to know information concerningthe patient's 2104 body temperature. Two general approaches exist forgaining information concerning a physiological parameter. The monitoringsystem 2000 may be adapted for interfacing with a physiologicalparameter-measuring unit, as has been disclosed with reference to otherembodiments of the invention. The parameter-measuring unit can thendirectly measure the physiological parameter and transmit the data tothe central computer 2100. Many times, this is an appropriate approach.Accordingly, according to one embodiment of the invention, themicroprocessor 2106 may interface with a physiologicalparameter-measuring device, such as a scale or a thermometer, aspreviously described herein. On the other hand, oftentimes it ispossible to ask the patient to measure the parameter for himself (e.g.,take his own temperature). This approach has an advantage, in that thecost of obtaining the information is minimized. This approach isparticularly useful when an exact measurement of a physiologicalparameter is not as useful as simply knowing whether the parametercrosses some threshold. Under these circumstances, the cost of directlyobtaining precise information may outweigh the financial benefit ofknowing such information. Thus, as depicted in FIG. 23, a questionhierarchy 2200 may be designed to ask a patient whether one of hisphysiological parameters exceeds a threshold, T.

The question hierarchy 2200 depicted in FIG. 23 is similar to thequestion hierarchies 2200 discussed with reference to FIG. 22. Thequestion hierarchy 2200 corresponds to a symptom identifier 2208, whichis transmitted to the patient monitoring device 2000 by a remotecomputer 2100. The hierarchy 2200 possesses several questions Q1, Q2,and Q3, some of which may go unasked, if a decision point D1, D2, or D3terminates the flow of questioning by transferring execution flow to aterminal point T1, T2 or T3. Of particular note in the questionhierarchy 2200 of FIG. 23 is the first question, Q1, and the firstdecision point D1. The first question, Q1, asks the patient 2104 if aparticular physiological parameter of his exceeds a given threshold, T.The value represented by T is transmitted to the patient monitoringdevice 2000 by the remote computer 2100, as is depicted by thresholddatum 2300. Therefore, to invoke this particular hierarchy 2200, theremote computer should transmit both a symptom identifier 2208 and athreshold datum 2300. In response, the patient monitoring device 2000responds by asking the patient 2104 if his particular physiologicalparameter exceeds the threshold, T. Next, as is depicted by decisionpoint D1, the patient monitoring device 2000 determines whether or notto proceed with further questions, on the basis of whether or not theparameter exceeded the threshold, T.

Another situation likely to arise in the context of monitoring a patient2104 with a chronic illness is that the patient 2104 is to be queriedregarding his faithfulness to a prescribed health care regimen. Forexample, if the patient 2104 is a diabetic, the patient is likely to beon a strict diet. The patient monitoring device 2000 may be programmedto ask the patient 2104 if he has been following his diet. If thepatient 2104 answers “yes,” the device 2000 may respond by praising thepatient 2104—a tactic that may be particularly advantageous for youngpatients. On the other hand, if the patient 2104 answers “no,” thedevice 2000 may respond by reminding the patient 2104 to adhere to hisdiet.

FIG. 24 depicts a question hierarchy 2200 designed to achieve theresults of praising a patient 2104 for adhering to a prescribed regimen,or reminding the patient 2104 of the importance of adhering thereto. Ofparticular note in the question hierarchy 2200 depicted in FIG. 24 isthe first question, Q1. The first question, Q1, asks the patient 2104 ifhe has been adhering to a health care regimen (such as, a diet or amedication regimen). Next, at decision point D1, flow of execution isadjusted based upon whether or not the patient 2104 has been adhering tothe regimen. If the patient 2104 has been adhering to the regimen, thepatient 2104 is presented with a statement, S1, praising the patient.Otherwise, the patient 2104 is presented with a statement, S2, remindingthe patient 2104 to adhere to his regimen. In either event, executionflow is passed to the second question, Q2, and hierarchy executioncontinues in accordance with the flow described with reference to FIG.22.

FIG. 25 depicts a question hierarchy 2200 that has been modified topermit the remote computer 2100 to command specific questions within thehierarchy 2200 to be asked, regardless of any answer that may have beenpreviously given by the patient 2104. To achieve this result, the remotecomputer 2100 should transmit a symptom identifier 2208 corresponding tothe question hierarchy 2200. Additionally, a question set 2500 should betransmitted. The question set 2500 may define a set of questions to beforced “on.” For example, the question set 2500 may be {3, 5}, meaningthat questions 3 and 5 are to be asked, no matter what the patient 2104has previously answered.

Continuing the discussion assuming that a question set 2500 of {3, 5}had been transmitted, execution of the hierarchy commences with theasking of the first question, Q1. Next, at decision point D1, thepatient's 2104 answer to the first question is assessed to determinewhether the subsequent question in the hierarchy should be asked. If theanswer is such that ordinarily none of the remaining questions should beasked, execution would typically flow to terminal point T1. However, inthis embodiment, a second decision point, D2, is interposed betweendecision point D1 and terminal point T1. At the second decision point,D2, it is determined whether the question set 2500 contains a questionnumber that is higher than the question number that was just asked. Inthe case of the present example, the question set 2500 contains two suchquestion numbers, because question numbers 3 and 5 are higher than thepresent question number, 1. If the question set 2500 does contain aquestion number that is higher than the question number just asked, thenexecution flows to the smallest such question number (in this case,question number 3, Q3). Thereafter the process repeats, thereby ensuringthat each of the question numbers in the question set will be asked.

FIG. 26 depicts a question hierarchy 2200 that has been modified topermit the remote computer 2100 to command a specific sequence in whichthe questions within the hierarchy 2200 should be asked. To achieve thisresult, the remote computer 2100 should transmit a symptom identifier2208 corresponding to the question hierarchy 2200. Additionally, asequence set 2600 should be transmitted. The sequence set 2600 is a setof data defining the order in which the questions are to be asked. Forexample, the sequence set 2600 may be {3, 1, 2}, meaning that thequestion that would ordinarily be asked third should be asked first,that the question that would ordinarily be asked first should be askedsecond, and that the question that would ordinarily be asked secondshould be asked third.

Continuing on with the example, execution of the hierarchy 2200 of FIG.26 commences with a look-up operation, L1. During the look-up operationL1, the first element of the sequence set 2600 is used to index into anarray containing the questions within the hierarchy. In the presentexample, since “3” is the first element of the sequence set, the thirdquestion from the array is retrieved. Next, the retrieved question(identified as Q1 in FIG. 26) is asked, and execution of the hierarchyproceeds as has been generally described with reference to FIG. 22.Thus, by inserting a look-up operation L1, L2, or L3 prior to eachquestioning operation Q1, Q2, or Q3, any desired sequence of questioningmay be commanded.

The question hierarchies disclosed in FIGS. 22-26 may be programmed intothe memory device 2108 of the patient monitoring device 2000, therebyobviating the need to transmit the text of the questions from thecentral computer 2100 to the patient monitoring device 2000. One skilledin the art understands that the question hierarchies 2200 may beimplemented in the form of an application-specific integrated circuit,as well. Optionally, the questions within the hierarchies 2200 maywritten to be answered with either a “yes” or “no,” achieving theadvantage of simplifying the input required from the patient 2104, andthereby necessitating only “yes” or “no” buttons for the input device2006. Further, any of the preceding question hierarchies 2200 forms maybe combined.

As described earlier, the memory device 2108 may store each of thequestion hierarchies 2200 in a plurality of languages, so as to permitpatients 2104 of many nationalities to use the device 2000. If theoutput device 2004 is an audio output unit, the questions within each ofthe question hierarchies 2200 may be stored in a digital audio format inthe memory device 2108. Accordingly, the questions are presented to thepatient 2104 as a spoken interrogatory, in the language of the patient's2104 choice.

FIG. 27 depicts a method by which the patient's 2104 answers to thequestions presented in the hierarchies 2200 may be analyzed. Asmentioned earlier, depending upon the outcome of the analysis, anexception report may be issued and a health care provider may benotified. According to the method depicted in FIG. 27, during operation2700 a point value is assigned to each question in each of the invokedquestion hierarchies 2200. The points assigned to a given question are“earned” by a patient 2104, if the patient answers the question in aparticular way. Otherwise, no points are earned. For example, anaffirmative response to the question “are you experiencing shortness ofbreath?” may be worth 10 points, while a negative response to thatquestion is worth nothing. A standard point value may be assigned toeach question (each question has a point value of 10, for instance), ordifferent questions may be assigned different point values (a firstquestion is worth 10 points, while a question directed toward a moreserious issue may be worth 30 points, for example). A default pointassignment scheme may be presented for approval by a health careprovider. The health care provider may then adjust the point assignmentscheme to fit the needs of an individual patient 2104.

In operation 2702, the point value of each of the questions actuallyasked to the patient 2104 is determined. Thus, questions that were notasked to a patient 2104 are not included in this point total. Inoperation 2704, the patient's 2104 earned point value is totaled. Then,in operation 2706, the patient's 2104 earned point total (determined inoperation 2704) is divided by the total possible point value (determinedin operation 2702).

In operation 2708, it is determined whether the fraction found inoperation 2706 exceeds a threshold (as with the point assignment scheme,the threshold may be defined by the health care provider). If so, thepatient's health care provider is notified (perhaps by the issuance ofan exception report), as shown in operation 2710. Finally, the processterminates in operation 2712.

FIG. 28 depicts another method by which the patient's 2104 answers tothe questions presented in the hierarchies 2200 may be analyzed.According to the method depicted in FIG. 28, during operation 2800 apoint value is assigned to each question in each of the invoked questionhierarchies 2200. The details of the point assignment scheme areidentical to those in operation 2700 of FIG. 27.

Next, in operation 2802, a threshold is assigned to each invokedhierarchy 2200. Again, this threshold may be assigned by default, andthe health care provider may be given an option to adjust thisthreshold. The threshold of operation 2802 applies to each hierarchy2200, meaning that a decision will be made, on a hierarchy-by-hierarchybasis, whether the patient 2104 has accumulated sufficient points in aparticular hierarchy to cross a threshold assigned to that hierarchy2200. In operation 2804, a second threshold is assigned. The thresholdof operation 2804 relates to the number of hierarchies 2200 that may beallowed to exceed the threshold of operation 2802.

In operation 2806, the number of points earned by the patient 2104 ineach hierarchy 2200 is determined. Then in operation 2808, it isdetermined whether the number of hierarchies 2200 in which the thresholdof operation 2802 was crossed exceeds the threshold of operation 2804.If so, the patient's health care provider is notified, as shown inoperation 2810. Finally, the process terminates in operation 2812.

The methods of FIGS. 27 and 28 are preferably performed by the remotecomputer 2100, although they may be performed by any other processingdevice. The aforementioned methods are preferably embodied as softwarestored in a memory device within the central computer 2100. However,they may be embodied on a computer-readable medium, such as a compactdisc, a floppy disc, a network cable, or any other form of mediareadable by a computer.

Weight Loss/Weight Management System

FIG. 29 depicts a questioning scheme that may be employed by any of theembodiments of the system depicted or referred to in any of thetwenty-eight preceding figures. As can be seen from FIG. 29 there isshown a first sequence of questions which have been organized intocategories 2900, 2902, 2904, and 2906 and a second sequence of questionswhich have been organized into categories 2908, 2910, 2912, and 2914.Typically, all of the questions within a category such as category 2900relate to a given topic. In the case of a system for weight loss orweight management, for example, the category may relate to overeating,and each of the questions may relate to different facets of overeating.

As shown in FIG. 29, the typical flow for such a scheme is for thequestions within a first category, such as category 1 2900, to be askedfollowed by the questions within a second category, such as category 22902, to be asked. Following this, the questions in category 3 2904 areasked, and finally the questions in category 4 2906 are asked. Ofcourse, in principle, a questioning scheme may have questions organizedinto any number of categories not simply four as is shown in FIG. 29.Further, it is not necessary that the categories be preceded through insequential fashion, although this is has been shown in FIG. 29.

As shown by the question sequence composed of categories 2908, 2910,2912, and 2914, a given category of questions may be deactivated. Inthis example category 2 2910 is deactivated, as is indicated by thecross hatching. In such an instance, the questions within category 12908 are asked, category 2 is skipped because it is deactivated, and theexecution flow proceeds to category 3 2912 and category 4 2914. As isdiscussed later, it is possible for any number of categories to beactivated or deactivated and it is also possible to activate ordeactivate categories based on a predetermined schedule such asactivating or deactivating categories based on the day of the week. Forexample, category 2 2910 may be activated on Mondays, Wednesdays andFridays and deactivated on Tuesdays, Thursdays, Saturdays and Sundays.Similarly, example category 4 2914 may be activated on Mondays, Tuesdaysand Wednesdays, but deactivated on Wednesdays, Thursdays, Fridays,Saturdays, and Sundays. Categories may be activated and deactivatedbased on date ranges, as well.

FIG. 30 depicts a question sequence composed of four categories 3000,3002, 3004, and 3006. As was the case in FIG. 29, the flow from categoryto category is largely sequential, in that the flow moves from category3000 to category 3002, skips over category 3004 because it is crosshatched and depicted as deactivated for the sake of example, andproceeding on to category 3006.

Intracategory execution flow is shown for the sake of example. Turningto question category 3000, it can be seen that therein is included aquestion 3008 followed by a branch instruction 3010. If, for example,category 3000 were related to the topic of overeating, question 3008 mayread “did you eat more than three meals today?” At branch instruction3010 the answer of the person using the monitoring unit is evaluated,and the flow of execution is directed based on the person's answer. Forexample if the person answered “no,” i.e., he did not eat more thanthree meals that day, the flow may go on to statement instruction 3012,which may be a praise statement. For example praise statement 3012 mayread “good job.” Execution flow would then move on to category 3002. Onthe other hand, if the person answered that he had eaten more than threemeals, execution flow would have moved from branch instruction 3010directly to category 3002.

Category 3002 shows an intracategory execution flow that is a littlemore complicated than the one shown with reference to category 3000.Assuming for the sake of example that question category 3002 wasdirected toward the topic of emotional eating, then question 3014 mayread “were you happy today?” The flow then moves on to branchinstruction 3016. If the person had answers “yes,” flow proceeds on tothe next active question category, question category 3006 (becausequestion category 3004 is depicted as being deactivated). On the otherhand, if the person answers “no” to the question “where you happytoday,” then flow proceeds from branch instruction 3016 to follow-upquestion 3018, which may read “did you eat to feel better?” The person'sanswer is evaluated at branch instruction 3020. Assuming the personanswered that he did not eat to feel better, once again flow would moveon to question category 3006. On the other hand, if the person answeredthat he had eaten to feel better, then execution flow moves on toreminder statement 3022 which may read “Remember to stick to your mealplan.” Thereafter execution flow would move on to category 3006.

Thus, as can be seen from the preceding example, question categories3000, 3002, 3004, and 3006 may include: (1) questions related to atopic; (2) branch instructions that control the flow of execution basedupon the person's answer to the questions; (3) follow-up questions; and(4) praise or reminder statements based upon the person's answers to thequestions. Generally, the flow from category to category is sequential,although this is not necessary. Generally, execution flow skips overdeactivated question categories and proceeds on to the next activequestion category.

FIG. 31 depicts a question set having questions 3100, 3102, 3104, 3106,3108, 3110, and 3112. The question set in FIG. 31 is directed toward thetopic of meal planning. Thus each question within this category relatesto determining whether the person using the monitoring unit exhibiteddeliberate dietary habits throughout the day.

FIG. 31 also depicts the principle that the monitoring unit, such asmonitoring unit 10, may be put into a mode of operation. In the casewherein monitoring unit 10 is programmed for the purpose of encouragingweight loss or weight management, the monitoring unit may be programmedin either a weight loss mode or a weight management mode. Execution flowwithin a question category may be altered depending upon the mode thatthe monitoring unit is in. This principle is illustrated in FIG. 31.

Execution flow begins with question 3100: “Are you having regularmeals/snacks?” If the person answers “yes,” and if the monitoring unitis in weight management mode, execution flows to praise statement 3101,which may read, “You are focused on your goals!” Thereafter, executionflow proceeds to question 3102. On the other hand, if the monitoringunit is in weight loss mode, execution flow moves on to question 3102,regardless of the person's answer. Question 3102 reads, “Are youchoosing healthy foods?” Once again, if the person answers “yes,” and ifthe monitoring unit is in weight management mode, execution flow moveson to praise statement 3103, which may read “Great job with this system!Keep it up!” As before, if the monitoring unit is in weight loss mode,execution flow moves on to question 3104, irrespective of the person'sanswer. Question 3104 reads “did you follow your meal plan?” If theperson answers “yes,” execution flow moves on to praise statement 3105.Praise statement 3105 may be different based upon whether the monitoringunit is in weight loss mode or weight management mode. For example, ifthe monitoring unit is in weight loss mode, praise statement 3105 mayread, “You're on your way to success.” If on the other hand themonitoring unit is in weight management mode, praise statement 3105 mayread, “Good job!” Thereafter as can be seen from FIG. 31 the remainingquestions in this question category are skipped and the next activatedcategory is executed. On the other hand if the person were to answer“no” to question 3104, execution flow moves on to question 3106, whichreads “Did you eat more than N calories”. “N” is a variable which may beset by the remote computer, such as the remote computer 32 depicted inFIG. 4, and may be individualized for a particular user. Thereafter,execution flow moves on to question 3108, which reads “Did you followyour breakfast meal plan?” Irrespective of the person's answer,execution flow moves on to question 3110, which reads “Did you followyour lunch meal plan”. If the person answers “yes,” and the monitoringunit is in weight loss mode, execution flow moves on to praise statement3114, which may read “Great job with this system! Keep it up!”Thereafter, execution flow moves on to question 3112. On the other hand,if the monitoring unit is in weight management mode execution flow movesfrom question 3110 to question 3112 irrespective of the person's answer.The final question in the exemplary question category reads “did youfollow your meal plan?” Upon answering this question execution flowmoves on to the next active category.

Although FIG. 31 shows specific questions that may be included within aquestion category directed to meal planning, other question categoriesmay exist in a system for weight loss or weight management. Thosecategories may include categories directed toward dietary recording,overeating, skipping of meals, eating at home, portion size, eating out,grocery shopping behavior, label reading, water consumption, happiness,stress, depression, support, body image, fit of clothing, bodymeasurements, program satisfaction, exercise and lesson plans.

In sum, FIG. 31 depicts the following general principles. The monitoringunit may be programmed to be in one of a plurality of modes ofoperation. Based on the mode of operation, the monitoring unit may alterintracategory and/or intercategory execution flow. For example, themonitoring unit may ask a different follow-up question, may give adifferent praise or reminder statement, may execute a differentcategory, may omit a follow-up question, and/or may omit a praise orreminder statement, based upon the selected mode of operation. Althoughnot depicted by FIG. 31, each of the questions (such as 3100-3112)within a category is individually activatable and deactivatable.Individual questions may be activated or deactivated according to aschedule, or may be activated or deactivated indefinitely. For example,any question within a group may be deactivated for a given use, althoughthe group as a whole may be active. Thus, for example, the question “Areyou choosing healthy foods?” (question 3102) may be activated onMondays, Wednesdays and Fridays, but deactivated on Tuesdays, Thursdays,Saturdays and Sundays. Conversely, a question may be activated, althoughthe group in which the question resides is deactivated. Suchprogrammability permits a manageable number of questions to be presentedto the person using the monitoring unit. Further, such programmabilityallows the person's experience to vary from day to day, so that theperson maintains his or her interest in the unit.

The questioning schemes depicted in FIGS. 29-31 may be embodiedaccording to the question hierarchy technology described with referenceto FIGS. 20-28 herein. Such an embodiment is within the scope of theinvention and disclosure herein.

FIG. 32 depicts an example of execution flow for a monitoring unitdesigned for encouraging weight loss or weight management. As can beseen from FIG. 32, the monitoring unit may initially ask the personquestions related to weight loss or weight management according to aquestioning scheme as described with reference to FIGS. 29 through 31.Further, the monitoring unit may measure the weight of the person asshown in operation 3202. After execution of operation 3202, themonitoring unit may transmit the person's answers to the questions andthe person's weight to a remote computing system so that the informationcan be processed and stored and so that the remote computing system candetermine if a health care provider should be alerted. Details relatedto generation of alerts for health care providers are discussed below.Finally, as shown in operation 3204, the monitoring unit may presentweight loss progress statements to the person. The weight loss progressstatements may take on several forms, each of which may be activated ordeactivated during designated time intervals, as is discussed below. Forexample, one form of progress statement may be activated during Mondays,Tuesdays, and Wednesdays, while another form is activated on Thursdays,Fridays, Saturdays, and Sundays.

Examples of weight loss progress statements include a presentation ofthe person's present weight followed by the presentation of the person'sweight at some point in the past such as a week ago, a month ago, threemonths ago, six months ago, nine months ago, a year ago or even twoyears ago. Alternatively, a weight loss progress statement may include apresentation of the person's present weight followed by the person'saverage weight (or some other measure of central tendency) over aparticular time interval such as that person's average weight one weekago, one month ago, three months ago, six months ago, nine months ago, ayear ago, or even two years ago. As another alternative, the person maybe presented with their weight when they began using the monitoring unitand may also be presented with his or her present weight. Yet anotheralternative is a presentation of the person's present weight and apresentation of the person's milestone weight. A milestone weight is aweight that is intermediate the person's weight when he or she beganusing the monitoring unit and a final goal weight that the person wantsto achieve. Still further, a weight loss progress statement may includea statement of the percentage of the total weight loss goal the personhas met, or a statement of the person's total weight loss goal. If themonitoring unit is in weight maintenance mode as opposed to weight lossmode, the progress statement may include a statement of what themaintenance weight is for the particular person. The maintenance weightmay actually be a range. For example a person having a weight goal of165 pounds may have a maintenance weight range between 160 and 170pounds.

Although the discussion related to the progress statements generated inoperation 3204 of FIG. 32 has been in the context of discussing weightloss, progress statements may be produced for any other measurableparameter. For example, a progress statement may be generated to showthe variation, over an interval of time, in activity level or number ofsteps a person has taken. Other examples of parameters that may be thesubject of progress statements include caloric intake, fat intake, waterconsumption, intake of dietary fiber, vitamin intake, or intake of anyother nutritional item.

FIG. 33 depicts a program phase screen that permits a user of the remotecomputing system, such as remote computer 32 shown in FIG. 4, to dividethe person's weight loss or weight management program into phases. Aphase is an interval of time during which certain question categoriesare asked while other question categories are not asked. A phase may beadded by selecting the “add phase” button 3310. This selection allowsthe user to select a phase name entered in field 3300, a start date forthe phase entered in field 3302, and end date for the phase entered infield 3304, and an emphasis group entered in field 3306. The emphasisgroup identifies the question categories that are to be executed by themonitoring unit between the start date 3302 and end date 3304. Forexample, if the user of the remote computing system wished the personusing the monitoring unit to have questions related to meal planning andovereating presented to them during a first phase, the emphasis group3306 would include meal plan and overeating categories but may excludeother categories not appropriate for this phase. Notes associated witheach phase may be stored in the note field 3308. To remove a phase,highlight the particular phase and select the “remove phase” button3312. In principle a weight loss or weight management program may bedivided into any number of phases, not simply a weight loss and weightmanagement phase.

Phases permit a user of the remote computing system to customizequestioning appropriate to a particular person's needs. One additionalbenefit of phases is that it prevents the person using the monitoringunit from always being presented with the same set of questions.

FIG. 34 depicts a verification screen in which patient data is displayedin the upper left-hand corner. As can be seen from FIG. 34, the patientdata portion of the screen is a grid having rows labeled Acute, SxScore, Sx Variance, Compliance and Weight and columns labeled Today,Last, Change and Trigger. The first four row labels relate to differenttypes of questions. The monitoring unit may be programmed to ask threedifferent kinds of questions: (1) acute questions; (2) compliancequestions; and (3) scored questions. Acute questions are questions thatattempt to determine whether the person needs immediate attention. Forexample, the person's answers to acute questions may indicate that theperson needs contact with an operator, case manager, health careprofessional, dietician, counselor or any individual responsible formonitoring the person's information or overseeing the person's weightloss or weight management. Compliance questions determine whether theperson needs follow-up because that person is simply not complying withthe plan, and scored questions may be used to determine whether theperson needs follow-up because the person's answers, in general,indicate that the plan is not working for one reason or another. Theterm “Sx” (which typically is known to be an abbreviation for “symptom”)is used to refer to scored questions. As the term is used herein, theterm “symptom” or “Sx” refers not just to physical symptoms, but tolifestyle modifications (e.g., cooking at home more often), behaviormodifications (e.g., reading food labels), psychological outlook (e.g.,having a happy or depressed state of mind), actions undertaken by theperson using the monitoring unit, or other information relating tosuccess or failure of weight loss or weight management for the personusing the monitoring unit. Thus, questions relating to “symptoms” mayinquire into any sort of information relating to success or failure ofweight loss or weight management for the person using the monitoringunit.

Turning first to the row labeled “acute,” there are two fields, fields3400 and 3402, which may contain data. Field 3400 contains an indicationof whether the person is considered acute on the present day, and field3402 contains an indication of whether the person was considered acutethe last time the person used the monitoring unit. If a person isdetermined to be acute, an alert may be sent to a health careprofessional so that the health care professional can contact theperson. The determination of whether a person is acute may be made onthe basis of a person's answer to a single question. For example, if aperson were to answer “no” to the question “Do you feel life is worthliving,” this single answer would cause the system to determine that theperson was acute. On the other hand, the system may determine that aparticular person is acute on the basis of answers to several questions.For example consider the following three questions: (1) Were youstressed today?; (2) Are you finding ways to manage your stress?; and(3) Were you angry today? An affirmative response to all three questionsmay be sufficient to trigger the decision that the patient is acute.

Moving on to the next row, which is labeled “Sx Score,” it can be seenthat this row contains four fields, fields 3404, 3406, 3408 and 3410.This row and the following row, labeled “Sx Variance,” relate to scoredquestions. Scored questions are general questions that have a pointvalue or score associated with them. “Points” are accumulated based uponthe person's answers to the scored questions. A total score may betallied for each use of the monitoring unit. Field 3404 shows theperson's present total score, while field 3406 shows the total scoreearned by the person the last time the person used the monitoring unit.Field 3408 shows the difference between the person's present score andthe score the last time he or she used the unit. Field 3410 shows atriggering condition, which indicates whether an alert will be generatedbased upon the person's answers to the scored questions. The triggercondition may be a simple threshold to which the person's score iscompared or can be a threshold based upon a percent score. For example,the threshold may be a score of twenty, with any score exceeding thethreshold causing the remote computing system to generate an alert.Alternatively the trigger 3410 may express a trigger condition that isactivated when a person's score changes by more than a given number ofpoints in a given number of days. For example, an alert may be generatedif the person's score changes by more than ten points in three days.

As stated above, the trigger condition may be expressed as a percentagevalue. Per such a scenario, the scoring scheme may be implemented asfollows. A score is assigned to each answer provided by the person usingthe monitoring unit. A total score is arrived at by summing each of thescores earned by the person's various answers. The total score isdivided by the total possible score the person could have earned. Thetotal possible score, which serves as the divisor, is arrived at bysumming the highest scores available for each question actually posed tothe person using the monitoring unit. Questions not actually posed tothe person using the monitoring system do not figure into thecalculation of the total possible score. The quotient arrived at per thepreceding procedure is compared to a percentage threshold. If thequotient exceeds the threshold, an alert is generated.

The third row, labeled “Sx Variance” relates to the variance in scoresearned by the person using the monitoring unit. For example, field 3412presents the variance in score earned by the person using the monitoringunit, and field 3414 presents the variance in scores earned by theperson the last time the person used the monitoring unit. Field 3416shows the difference between field 3412 and 3414. Field 3418 relates toa trigger condition which if satisfied, may cause the remote computingsystem to generate an alert. For example, an alert may be generated if aperson exhibits a change in variance that exceeds a given percentageover a given number of days.

The fourth row is labeled “Compliance” and has four fields, fields 3420,3422, 3424, and 3426. This row relates to the way the person using themonitoring unit answers the compliance questions. One point may beearned for each answer indicating that a person is not complying withthe plan. Field 3420 shows the number of compliance points earned, andfield 3422 shows the number of compliance points earned the last timethe person used the monitoring unit. Field 3424 shows the differencebetween fields 3420 and 3422. Field 3426 presents a trigger conditionwhich if satisfied may cause the remote computing system to generate analert. For example, an alert may be generated if a person earns morethan a given number of compliance points in a given number of days.

The fifth and final row is labeled Weight and contains four fields,field 3428, 3430, 3432 and 3434. Field 3428 shows the person's currentweight, and field 3430 shows the person's weight the last time the he orshe used the monitoring unit. Field 3432 shows the difference betweenfield 3428 and 3430. Field 3434 indicates a trigger condition which ifsatisfied may cause the remote computing system to generate an alert.The alert condition expressed in field 3434 may be a simple threshold.For example, if the person's weight exceeds a threshold of 180 pounds, ahealth care professional may be alerted. Alternatively, the triggercondition expressed in field 3434 may relate to a change in the person'sweight. For example, if the person's weight changes by more than a givennumber of pounds in a given number of days, an alert may be generated.

The screen depicted in FIG. 34 also contains a weight parameter section,which contains fields 3436 through 3446. The data presented in thisportion of the screen allows the user of the remote computing system toobtain a quick overview of the weight condition of the person using themonitoring unit. Field 3436 presents the weight of the person using themonitoring unit at the point in time in which he began using themonitoring unit. Field 3438 presents a person's goal weight, which is aweight at which the person using the monitoring unit ultimately wants toreach. Field 3440 presents the person's milestone weight, which is aweight somewhere between the person's starting weight 3436 and goalweight 3438. The person's maintenance weight range is indicated in field3442. This weight range is the range the person should stay in afterreaching his or her goal weight. Field 3444 shows a threshold weightwhich if exceeded may cause the remote computing system to generate analert and field 3446 indicates a trigger condition caused by weightchange which if satisfied may cause the remote computing system togenerate an alert. For example, if field 3446 contains the data “5/10,”this would mean that an alert may be generated if the person exhibited aweight change of more than 5 pounds in 10 days.

The screen depicted in FIG. 34 also contains an exception portion, whichcontains fields 3448 and 3450. The data in fields 3448 and 3450 isintended to provide an indication to the user of the remote computingsystem of which questions caused an alert to be generated. In field3448, data is contained which indicates whether the alert was generateddue to answers to acute questions, scored questions or compliancequestions. Field 3450 contains the particular question that caused analert to be generated. For example, a person using the monitoring unitmay be indicated as being acute because of affirmative answers to thequestions: (1) Were you stressed today?; (2) Are you finding ways tomanage stress?; (3) Were you angry today? Per such a scenario, threeentries are found in the exceptions portion. The exceptions type field3448 reads “Acute” for all three entries. The first entry reads “Wereyou stressed today”. This second entry reads “Are you finding ways tomanage stress,” and the third entry would read “Were you angry today.”Thus, for each question that contributed to an alert being generated,there exists an entry in the exception portion of the screen depicted inFIG. 34. The text of the question is presented in field 3450 and thetype of the question is presented in field 3448.

The screen depicted in FIG. 34 also contains a portion relating totwo-way messages. This portion of the screen contains two fields, fields3452 and 3454. Field 3454 presents the text of a two-way message andfield 3452 presents the person's corresponding answer. Two-way messagingis discussed in detail herein in the portions of the specificationrelated to FIGS. 11 through 18.

Patient notes may be entered in field 3456, which is located in a noteportion of the screen.

A set-up screen is depicted in FIG. 35. The set-up screen contains ahealth check portion of the screen, which contains fields 3500-3508. Infield 3500, the user of the remote computing system can schedule thedays of the weeks on which reminders are to be turned on. An example ofa reminder was presented in FIG. 30 and labeled by reference numeral3022. (“Remember to stick to your meal plan.”) These forms of remindersmay be turned off. If reminders are deactivated, a reminder statement isnot presented, even if execution flow would ordinarily indicate that areminder is to be given. Thus, for example, reminders may be scheduledfor Monday, Wednesday, and Friday. On these days reminders will bepresented to the patient. On Tuesdays, Thursdays, Saturdays and Sundaysno reminders will be given to the patient. Similarly, praise statements(field 3502) may be scheduled for certain days of the week. Fields 3504,3506, and 3508 permit weight loss progress statements to be scheduledfor certain days of the week.

The screen depicted in FIG. 35 also contains a symptom parameter sectionin which the trigger condition depicted in fields 3410 and 3418 on FIG.34 may be set.

The screen depicted in FIG. 35 also contains a weight parameter sectionin which the information shown in fields 3436, 3438, and 3442-3446 inFIG. 34 may be set.

The screen depicted in FIG. 35 also contains an “Other Parameters”portion. In field 3510 and 3512, the height in feet and inches of theperson using the monitoring unit may be entered. In field 3514 thenumber of ounces of water the person using the monitoring unit is toconsume may be entered, and via the selection buttons identified byreference numeral 3516, the phase in which the monitoring unit isprogrammed to be may be selected. For example, the monitoring unit maybe selected for weight loss phase or weight maintenance phase. Otherparameters may be set from this screen, as well. In principle, thisportion of the screen may contain fields that allow entry of idealvalues for any parameter characterizing the person using the monitoringunit. For example, this portion of the screen may contain fields thatallow entry of ideal values distance the person is to walk, number ofsteps the person is to take in a day, number of calories the person isto consume in a day, and so on. The values entered in these fields maybe used in the process of generating an alert (described above) or inprogress reports. For example, an alert may be generated if the activitylevel of the person falls short of a threshold. Additionally, an alertmay be generated if, over a span of time, the person's number ofcalories burned, number of steps taken over, or distance walked fallsshort of a threshold. Still further, an alert may be generated if thenumber of calories consumed by the person using the monitoring deviceexceeds a threshold. The values compared against these thresholds may beinput manually (e.g., may be estimated) by the person using themonitoring device, or may be directly measured by a measuring devicethat communicates such data to the monitoring device. The thresholds maybe equal to the ideal values entered into the fields in this portion ofthe screen, or may be calculated therefrom, such as by multiplying thevalues in these fields by a factor (e.g., multiplying ideal caloricintake by 1.1 or 1.2).

The screen depicted in FIG. 35 also contains a “Questions” section. Thissection relates to the question hierarchy technology discussed withreference to FIGS. 20-28. For example the check box 3518 pertains to afirst question hierarchy, which is depicted as consisting of twoquestions. The check box 3518 allows the entire hierarchy to beactivated or deactivated. Check box 3520 permits a particular question,which is within the hierarchy controlled by check box 3518, to beactivated or deactivated.

A monitoring unit may be programmed to utilize a personal identifiercode. In such an embodiment the monitoring unit is rendered usable bymore than one person. For example, a user of the monitoring unitcommences his use of the monitoring unit by entering a personalidentifier code. The monitoring unit uses the personal identifier codeto determine the identity of the user. The monitoring unit proceeds toexecute on the basis of data (such as data presented on the screensdepicted in FIGS. 33-35) that is associated with the personal identifiercode. Thus, for example, the monitoring unit asks questions appropriatefor the particular user and responds with praise and reminder statementsappropriate for the particular user. The particular user's answers andmeasured weight are transmitted to a remote computing system inassociation with the personal identifier code. This permits the remotecomputing system to know whose data it has just received.

2Such an embodiment may be useful in a setting in which multiple membersof a family all desire to use the same monitoring unit. Alternatively,such an embodiment with the system may be useful in a health clubsetting in which one or a small number of monitoring units are used fora large populace of users. The personal identifier code may be a nameand/or a password that are entered into the input device of themonitoring unit (e.g., the personal identifier may be entered via akeypad into the monitoring unit). Alternatively, the personal identifiercode may be any sequence of data uniquely associated with a user of amonitoring unit. The personal identifier code may be encoded upon amagnetic strip, upon an infrared signal, or upon a radio frequencysignal.

2According to one embodiment, the monitoring unit may require its userto wear an activity meter. An activity meter is a device that measuresthe activity level of a person wearing the meter and determines anumeric indication of that activity level. Examples of activity metersinclude pedometers, accelerometers, and calorie counters. A caloriecounter is a device in which dietary input is entered, and on the basisthereof, calories consumed is arrived at. The monitoring unit may askthe user to enter readings from the activity meter so that thisinformation may be transmitted to the remote computing system.Alternatively, the monitoring unit may interface directly with theactivity meter so that the readings may be transmitted withoutintervention by the user. For example, with reference to FIG. 4, theactivity meter may be interfaced with IO port 28 so that the informationtherein can be communicated directly to CPU 38. The activity meter maycommunicate with the monitoring unit via a radio frequency link, aninfrared link, a wireless network, a wireless communication technologyand protocol such as Bluetooth® which is a set of wireless technologiesowned and made available from Bluetooth SIG Inc., or via a serial orparallel port embodied in a cradle, for example.

2Activity meters provide a way for the monitoring unit and remotecomputing system to verify the answers provided by the user of themonitoring unit with respect to exercise levels. In some cases thereadings provided by the activity meter may supplant any questioningregarding the exercise level of the person using the monitoring unit.

2Activity meters may be used to gather information related to a person'sactivity level over a period of time, so that the information can bepresented to that person. For example, the monitoring unit may prepare astatus presentation that compares the person's present activity level tothe person's activity level a week ago, two weeks ago, a month ago, sixmonths ago, a year ago, or two years ago. Alternatively, the monitoringunit may compare the person's present activity level with the person'saverage (or median or other measure of central tendency) activity levelover a past interval of time. The status presentation may be presentedto the person via the output device of the monitoring unit.Alternatively, the status presentation may be e-mailed to the person(from the remote computing system, for example), may be made availableto the person via a web site, may be presented via a printed report, ormay be faxed to the person, for example.

2A website may be provided as a front end access point to allow theperson using the monitoring unit (or another designated person such as ahealth care provider, spouse, or parent) to access information collectedby the monitoring unit. For example, the website may allow access to adatabase that stores information collected by the monitoring unit. Theperson gains access to the information in the database by entering apersonal identifier, which is a set of data uniquely associated with theparticular person. The database is accessed based upon the personalidentifier, and one or more webpages are then presented to the person.The webpages may include indications of the person's weight lossprogress (as discussed above), comparisons regarding the person'sactivity level (such as has been discussed above), or may present any ofthe information presented on the screen shown in FIG. 34. Alternatively,the indications of the person's weight loss progress, comparisonsregarding the person's activity level, or any of the informationpresented on the screen shown in FIG. 34 may be communicated from themonitoring unit to a device such as a palm-top computer, a televisionset, or a telephone (e.g., via a modem) for presentation to a designatedperson.

2Thus, it will be appreciated that the previously described versions ofthe invention provide many advantages, including addressing the needs inthe medical profession for an apparatus and method capable of monitoringand transmitting weight loss and/or weight maintenance parameters ofpersons to a remote site whereby a medical professional caregiver canevaluate such physiological and wellness parameters and make decisionsregarding the patient's treatment.

2Also, it will be appreciated that the previously described versions ofinvention provide other advantages, including (according to certainembodiments) addressing the need for an apparatus for monitoring andtransmitting such weight loss and/or weight maintenance parameters thatis available in an easy to use portable integrated single unit.

2Also, it will be appreciated that the previously described versions ofthe invention provide still other advantages, including addressing theneed for medical professional caregivers to monitor and manage thepatient's condition to prevent unnecessary weight gain and theoccurrence of health problems that are concomitant therewith.

2Although the invention has been described in considerable detail withreference to certain preferred versions thereof, other versions arepossible.

Automated Interactive Verification of an Alert Generated by a PatientMonitoring Device

2FIG. 36 depicts a patient monitoring scheme wherein an alert isinitially generated, and subsequently verified. As can be seen from FIG.36, the scheme includes two processes: an assessment process 3600 and averification process 3602. According to the scheme of FIG. 36, a patientmonitoring device (such as the patient monitoring devices 1100 or 2100depicted in FIGS. 11 and 21, respectively) may be configured to measureat least one physiological parameter exhibited by a patient, and toprompt the patient with a set of questions. As described previouslyherein, the physiological parameter may include the patient's weight,the patient's blood glucose level, the patient's transthoracicimpedance, etc. As also described previously herein, the questions mayrelate to the patient's perception of his or her physical condition(example: “Do your ankles exhibit swelling?” or “Do you feel shortnessof breath when you exercise?”).

2Upon acquisition of the physiological data and patient answers, aninitial assessment process 3600 is initiated. The assessment process3600 may be performed by the patient monitoring device, or may beinitiated by a remote computing system (such as the remote computingsystems 1102 or 2100 depicted in FIGS. 11 and 21, respectively) withwhich the patient monitoring device communicates. The assessment processanalyzes the patient answers and physiological data, as describedpreviously herein, in order to arrive at a preliminary conclusionregarding whether the patient may need medical attention (for example, apreliminary conclusion may be drawn that the patient is experiencing anacute episode of a chronic disease, and therefore receive furthermedical attention). If the assessment process 3600 determines that thepatient may need medical attention and/or further clinical triage, analert is generated. As used herein, the terms “alert” and “exception”are synonymous.

In response to the generation of an alert, a verification process 3602is initiated. The verification process 3602 involves analysis of boththe data set (answers and physiological data) operated upon by theassessment process 3600 and additional data. The additional data maycome in the form of additional patient answers to additional questions.On the basis of the original data set and the additional data, adetermination is made whether the patient actually needs medicalassistance.

2Traditionally, the verification process 3602 has been performed bytrained medical personnel, such as by a nurse, case manager or diseasemanager. Typically, a nurse obtains the original data set that was thebasis for the alert, and examines the information therein. Thereafter,the nurse places a telephone call to the patient, and questions thepatient further, in order to determine if further medical interventionis required.

2On any given day, a call center may expect to observe an alertgenerated by 10%-20% of its telemonitored patient populace. A typicalnurse can perform on the order of forty to fifty calls per day, meaningthat a single nurse can manage on the order of 250 patients. From thesefigures, it can be seen that the number of patients a particular callcenter can manage is directly related to the number of nurses oroperators employed. Unfortunately, nurses are oftentimes in short supplyand may be expensive. Therefore, employment of a multitude of nursestends to drive health care costs up, and perhaps prevents some of thepopulace from obtaining the health care services they need.

2To address the aforementioned challenge, the verification process 3602may be automated, so as to reduce or eliminate the need for nurseinvolvement in the process 3602. FIG. 37 depicts a kernel for automationof the assessment and verification scheme presented in FIG. 36.

2The kernel depicted in FIG. 37 includes modules. The modules may beembodied as software, firmware, or hardware, such as one or moreapplication-specific integrated circuits (ASICs), as is understood bythose of skill in the art. As can be seen, the kernel of FIG. 37includes modules for implementation of the assessment and verificationprocesses 3600 and 3602 described with reference to FIG. 36. Forexample, the kernel includes an alert generation module 3700. The alertgeneration module 3700 receives the physiological data and answers fromthe patient, and determines whether an alert should be generated.Examples of processes by which this initial assessment may be made aredisclosed above, and are therefore not presently reiterated. If no alertis generated, no verification is needed, and the process may halt. Onthe other hand, if an alert is generated, then a verification process3602 is initiated. Such process may begin immediately after a singledata element is input (such as a single answer or single physiologicaldata element). Such a single element may begin the interactiveassessment and verification process. Such an interactive process mayalso be used to provide immediate patient self-management feedback andrecommendations. In other words, reception of a single answer orphysiological parameter may constitute a sufficient basis upon which anassessment process may generate an alert. Accordingly, the verificationprocess may commence after the reception of but a single answer orphysiological parameter.

2To effect verification 3602, the original data set, which was the basisof the alert, may be received by a categorization module 3702. Thecategorization module 3702 assesses the original data, in order toclassify the alert in one or more categories. A category is a broadarticulation of why the alert was generated. For example, an alert maybe classified as a “high weight” alert, meaning that the alert wasgenerated because the patient's weight exceeds some threshold. Thus,“high weight” is an example of a category. Additionally, an alert may beclassified “symptom score” alert, meaning that the patient's answerscorresponded to a score exceeding a threshold. Examples of schemes forscoring of a patient's answers and for comparison of the score to athreshold are described previously herein, and are therefore notpresently discussed further. Other examples of assessments, categoriesand alerts are known, and other examples may readily present themselvesto those of skill in the art. Furthermore, other examples may be derivedand presented in many forms, which may include but are not limited tostatistically validated surveys such as the Kansas City Quality of Life,SF-12, SF-36, and others. Such assessments, categories, and alerts arewithin the scope of the present invention.

2In the wake of having classified the alert as falling into one or morecategories, recognizing that a single alert may comprise its owncategory, a data store 3704 of rules is accessed. The data store 3704contains a set of rules corresponding to each category. A rule or ruleset is retrieved for each category in which the alert was classified.For example, if the alert was categorized as falling within twocategories (e.g., “high weight” and “symptom score”), then two rule setsare retrieved (e.g., one rule set corresponding to “high weight” andanother rule set corresponding to “symptom score”). However, accordingto some embodiments, one or more rules or rules sets may be retrieved inthe absence of having categorized the alert. In any event, thereafter,the rule set(s) are passed to a testing module 3706. The testing module3706 tests the original data set against each rule within each retrievedrule set, and identifies which rules are “triggered.” A rule is said tobe “triggered” if its assessment results in an affirmative result or aBoolean “1”.

2A rule set is composed of various rules that the original data set,and/or historical recordings of past original data sets, and/or otherdata collected by the central computing system may be tested against tobetter understand the nature and/or cause of the alert. Therefore, eachtriggered rule may correspond to a hypothesized nature or cause of thealert, which may, in turn, correspond to a line of questioning helpfulin exploring the hypothesized nature or cause. For example, Table 6(below) presents a rule set corresponding to a “high weight” alert.

TABLE 6 Rule Set: High Weight Rule #1 Minimal Weight Gain & No AlertOver Past 20 Days Rule #2 Minimal Weight Gain & Alert For Two Or MoreDays Rule #3 Minimal Weight Gain & Positive Weight Trend Rule #4 MinimalWeight Gain & Report Of Missed Medication Rule #5 Minimal Weight Gain &Medication Side Effect Rule #6 Minimal Weight Gain & Hospitalized inPast 14 Days Rule #7 Moderate Weight Gain & No Alert Over Past 20 DaysRule #8 Moderate Weight Gain & Alert For Two Or More Days Rule #9Moderate Weight Gain & Positive Weight Trend Rule #10 Moderate WeightGain & Report Of Salty Meal Rule #11 Moderate Weight Gain & Report OfMissed Medication Rule #12 Moderate Weight Gain & Medication Side EffectRule #13 Moderate Weight Gain & Hospitalized in Past 14 Days Rule #14Moderate Weight Gain & No Alert In Past 7 Days Rule #15 SignificantWeight Gain Rule #16 Weight Gain For Two Or More Days Rule #17 MinimalWeight Gain & Report Of New Or Increased Symptoms Rule #18 ModerateWeight Gain & Report Of New Or Increased Symptoms Rule #19 ModerateWeight Gain Exhibited Over A Single Day Rule #20 Minimal Weight GainExhibited Over Past Two Days Rule #21 Moderate Weight Gain ExhibitedOver Past Two Or More Days Rule #22 Minimal Weight Gain For One Day & NoSymptoms Rule #23 Minimal Weight Gain For One Day & Usual SymptomsReported Rule #24 High Trigger Weight Change Within Minimal Weight Range& Current Weight Is Less Than Last Reported Weight Rule #25 ModerateWeight Gain Over High Weight Trigger & Weight Decreased From PreviousDay & Usual Symptoms Rule #26 High Trigger Weight Change Within MinimalWeight Range & Current Weight Is Less Than Last Reported Weight &Hospitalized For CHF Within Past 14 Days Rule #27 Moderate Weight GainExhibited Over A Single Day & No Symptoms

2As mentioned previously, the testing module 3706 tests the originaldata set against each rule within each retrieved rule set, andidentifies which rules are triggered. For each rule that is triggered, aquestion hierarchy is retrieved from a data store 3708. Of course,although FIG. 37 depicts data stores 3704 and 3708 as being distinctfrom one another, the data stores 3704 and 3708 may be embodied as asingle data store. A question hierarchy includes a set of questions.Each question has an answer that may be selected from a set of discreteanswers (e.g., “true-or-false,” or “a, b, c, or d”). The question may beposed to the patient, who selects an answer from amongst the set ofdiscrete answers. On the basis of the patient's answer, a subsequentquestion is posed, and/or an instruction is given, and/or a conclusionis reached, and/or an action is carried out. The answer to thesubsequent question, and/or the outcome of the action undertakendetermines the next question to be posed, and/or instruction to give,and/or conclusion to reach, and/or action to undertake, and so on. Eachquestion hierarchy is configured to explore the hypothesized nature orcause deduced from a given triggered rule. Examples of questionhierarchies are presented with reference to FIGS. 20-28 herein, and aretherefore not presently discussed further. Of course, one skilled in theart of medical diagnosis may readily create question hierarchiesdirected to exploration of triggered rules, and such questionhierarchies are within the scope of the present invention.

After retrieval of the question hierarchies from the data store 3708,some optional operations may be performed upon the hierarchies by anoptional preparation module 3710. For example, the preparation module3710 may inspect the retrieved question hierarchies for questionsincluded in more than one such hierarchy. The preparation module mayremove redundant questions, so that a given question is posed but asingle time to the patient. Further, the preparation module 3710 mayexamine the question hierarchy to determine if any of the questionstherein have already been posed to the patient prior to the initialassessment process 3600. If so, the answers thereto may be extractedfrom the original data set and inserted into an appropriate data spacein the question hierarchy, so that the patient is not re-asked aquestion that he or she was asked by the monitoring device. Further, thepreparation module 3710 may determine that the question hierarchyrequires modification based on the patients co-morbidities. Further, thepreparation module 3710 may examine prior questions posed to the patientand determine such new questions are inappropriate.

In the wake of operation of the optional preparation module 3710, thequestion hierarchies are presented to the patient via a prompting module3712. According to one embodiment, the prompting module 3712 may guidean operator through a series of questions, which the operator poses tothe patient via the telephone. For example, a first question may bepresented to the operator via an output device. The operator may posethe question to the patient, obtain the patient's answer, and enter theanswer via an input device, thereby obtaining a second question (orinstruction, etc).

Alternatively, all of the modules 3700, 3702, 3706, 3710, and 3712 anddata stores 3704 and 3708 may be programmed into a memory device in thepatient monitoring apparatus. Alternatively, all of the modules 3700,3702, 3706, 3710, and 3712 and data stores 3704 and 3708 may beprogrammed into an interactive television module or web interface. Forexample, the patient monitoring devices 1100 and 2100 presented in FIGS.11 and 21 include memory devices 1112 and 2108, respectively. Theaforementioned modules and data stores may be stored in theaforementioned memory devices 1112 and 2108, so that both the assessmentprocess 3600 and the verification process 3602 are performed by thepatient monitoring device.

Whether the modules are embodied in software/firmware stored in thepatient monitoring device, or whether they are stored in the remotecomputing system, the outcome of presentation of the questionhierarchies to the patient may include a determination of whether or notthe patient needs to consult with a health care professional orotherwise see or speak with a physician or nurse. Other outcomes arepossible. For example, the verification process 3602 may interact withsoftware executed by the remote computing system. Such software isdescribed in U.S. patent application Ser. No. 10/788,900, filed on Feb.27, 2004 by Cosentino, and entitled “SYSTEM FOR COLLECTION,MANIPULATION, AND ANALYSIS OF DATA FROM REMOTE HEALTH CARE DEVICES,”which is hereby incorporated by reference for all it teaches. Accordingto one embodiment, the software is configured to interact with theverification process 3602, so as to automatically create a follow-upentry or an intervention entry, when appropriate. For example, if thequestion hierarchy arrives at a point whereby an instruction is given tothe patient to increase his medication dosage, an intervention entry isautomatically created reflecting this action. Similarly, if the questionhierarchy arrives at a conclusion that a follow-up action must be takenin the future, a follow-up entry reflecting this conclusion may beautomatically created.

Automatic Initiation of Data Transmission

According to one embodiment, the outcome of the verification process3602 or assessment process 3600 may initiate a data communication (e.g.,telephone call, page, short message service exchange, etc.) to medicaloffice or call center. For example, traversal of a question hierarchymay lead to a conclusion that a nurse or other professional needs to becontacted, to schedule a medical appointment, for example, or forfurther assessment of the patient, or for other medical care planmanagement. At such a juncture, the patient monitoring apparatusautomatically initiates a data transmission, telephone call, or othercommunication session to the appropriate network address, telephonenumber, or receiving location. For example, the data transmission may becarried out by a modem, telephone, cellular telephone, television,pager, hand-held wireless device, or other apparatus, that is integratedwith, or otherwise in communication with, the patient monitoring device.An example of such a system is depicted in FIG. 38.

FIG. 38 is a high-level depiction of a monitoring system employing theaforementioned embodiment. As can be seen from FIG. 38, the systemcomprises a patient monitoring apparatus 3800, a central computer 3801,and a computer system 3818 located at an oversight association, such asan HMO. The central computer 3801 is housed within a facility 3802 thatis located remote from the patient monitoring apparatus 3800. Forexample, the patient monitoring apparatus 3800 may be located in thehome of an ambulatory patient 3805, while the central computer 3801 islocated in a call center, disease management company or health carefacility 3802. The central computer may be coupled to a communicationnetwork 3810 or 3819, such as to the Internet, public switched telephonenetwork, or other network.

As described previously, the patient monitoring apparatus 3800 iscomposed of a central processor unit 3806, which is in communicationwith an input device 3807, an output device 3804, and a memory device3808. The memory device 3808 may have each of the modules and datastores described with reference to FIG. 37 stored therein. Additionally,the memory device 3808 may have a telephone number or network address,etc. to contact in the event that a nurse follow-up telephone call orcommunication session is necessitated stored therein.

As discussed previously, the output device 3804 may be used to promptthe patient 3805 with questions regarding the patient's wellness and mayalso provide immediate feedback to the patient based on such answers.The output device 3804 may consist of a visual display unit such as LCD,touch-screen or television that displays the questions in a language ofthe patient's 3805 choosing. Alternatively, the output device 3804 mayconsist of an audio output unit that vocalizes the questions andcombined with an input device such as an interactive voice responsesystem records such answers. In one embodiment, the audio output unit3804 may vocalize the questions in a language of the patient's 3805choosing. As yet another alternative, the input device 3807 and outputdevice 3804 may be embodied jointly as an interactive voice responsesystem.

The patient monitoring apparatus 3800 communicates with the centralcomputer 3801 via a network 3810; the patient monitoring apparatus 3800uses a communication device 3812 to modulate/demodulate a carrier signalfor transmission via the network 3810, while the central computer 3801uses a communication device 3814 for the same purpose. Examples ofsuitable communication devices 3812 and 3814 include internal andexternal modems for transmission over a telephone network, network cards(such as an Ethernet card) for transmission over a local area network, anetwork card coupled to some form of modem (such as a DSL modem or acable modem) for transmission over a wide area network (such as theInternet), or an RF transmitter for transmission to a wireless network.Of course, the oversight association's computer 3818 may use a similarcommunication device 3820 for the same purpose, as well. The patientmonitoring device 3800 may include a physiological parameter transducer(not depicted) in data communication with the processor 3806.Alternatively, the patient monitoring device 3800 may couple to anexternal physiological parameter transducer through an input/outputport, for example. Alternatively, the patient monitoring device maycommunicate via telemetry, RF transmission, or other wireless means withan implanted device such as a pacemaker, defibrillator orsynchronization device as described above in the present document. Forexample, a portion or all of the physiological parameter data may becommunicated to the patient monitoring device from an implantablemedical device, such as a pacemaker, defibrillator, cardiacresynchronization therapy (CRT) device, stimulator, etc. Additionally,the patient monitoring device 3800 may exclude a physiologicaltransducing unit altogether.

If during traversal of the question hierarchies, it is determined that adata transmission should be initiated with a medical attendant (e.g., anurse, physician, health care attendant, etc.), then the patientmonitoring device 3800 may initially transmit the data set operated uponby the verification process (or some subset thereof) to the centralcomputer system 3801 (this is an optional step).

Next, the patient monitoring device 3800 may attempt to establish atwo-way communication session with a nurse or other professional at thecall center, clinic, etc. 3802. The two-way communication session mayoccur as a computer-to-patient monitoring device session transactedthrough the network 3810. Per such a scenario, the nurse or otherprofessional could observe the data set initially transmitted to thecentral computer 3801, and could then join the electronic two-waycommunication session to make further inquiry of the patient 3805.

Alternatively, the patient monitoring apparatus may make use of anothercommunication device 3816, by which a communication session is initiatedwith another communication device 3822 accessed by the professional atthe call center 3802. For example, the communication device 3822 may bea telephone, a cellular telephone, a pager, a Blackberry® device, orother wireless communication device. The communication device 3816utilized by the patient monitoring device 3800 may initiate acommunication session with the professional's device 3822, so thattwo-way communication may be established. Per this scenario, the dataset operated upon by the verification process (or some subset thereof)may be transmitted from the patient monitoring device 3800 to theprofessional's communication device 3822. As an alternative, the centralcomputing system 3801 may communicate the information to theprofessional's communication device 3822. In either event, at the timethat the two-way communication session is initiated, the professionalhas access to the information, so that the professional has data thatserves as the basis for further inquiry of the patient 3805.

In the event that the communication device 3816 is embodied as atelephony device, then the processor 3806 may initiate a telephone callvia a telephone unit 3816 under the control of the processor 3806. Thetelephone unit 3816 may be instructed of the appropriate number to callby the processor 3806, or may be preprogrammed to call a specifictelephone number. Thus, immediately at the time the question hierarchyis interacting with the patient, a nurse may be called, thereby savingthe nurse time and effort of having to initiate the telephone call. Inthe event that the communication device 3812 is a telephone modem, thetelephone unit 3816 may be integrated as a part of the modem 3812, withan external speaker and microphone coupled thereto for facilitation ofconversation between the nurse and the patient. Alternatively, ifembodied as a distinct device, the unit 3816 may include a speaker andmicrophone suitable for enablement of “speaker phone” communication.

It is possible that, for one reason or another, the two-waycommunication session cannot be established (example: communicationdevices 3816 and 3822 are telephonic devices, and the call center's 3802telephone lines are busy). In such an instance, subsequent re-attemptsto establish the communication session may be initiated by the patientmonitoring apparatus 3800. If, however, a threshold number ofre-attempts (e.g., twelve re-attempts) prove fruitless, then a datatransmission may be made to the computer system 3818 at the oversightassociation. According to one embodiment, the patient monitoring deviceinitiates the data transmission to the computer system 3818, andtransmits a data packet containing content sufficient to inform thatoversight association's computer 3818 that the patient 3805 has not yetbeen contacted. According to one embodiment, the aforementioned datapacket may have a unique code associated therewith. Thus, when a two-waycommunication session is finally established between the patient and theprofessional, a corresponding code may be transmitted from theprofessional's communication device 3822 or computer system 3801 to theoversight association's computer 3818 to confirm that the patient 3805has been contacted.

Parameter Adjustment

When managing large patient populations, constant parameter adjustmentis required. Such parameter adjustment for biometric measurements,symptom thresholds and other parameters requires a skilled resource andcan be time intensive. The central computing system (such as computingsystem 3801) may be programmed to automatically readjust certainparameters from time to time. The graph depicted in FIG. 39A presents abackground for understanding this feature. A Cartesian plane is depictedin FIG. 39A, with a measured or calculated variable presented along they-axis, and successive measurements presented along the x-axis. Themeasured variable describes a quantifiable condition or state of thepatient's body. For example, the measured variable may be weight, bloodglucose, blood oxygen level, blood pressure, transthoracic impedance(examples of measured variables), or may be a score describing apatient's self-reported symptoms (an example of a calculated variable).Oftentimes, such scores are monitored as a part of the assessmentprocess 3600 (FIG. 36), as has been described above. An alert may begenerated when the score exceeds a threshold (or falls beneath athreshold), when a score exhibits a sustained trend (e.g., weightincrease exhibited over the span of at least N days), or when a score asmeasured or calculated on a given day differs from a score as measuredor calculated on a previous day by more than a prescribed quantity, etc.

Notably, each of the aforementioned sorts of variable monitoring schemesshares a common premise, namely, that a change in the monitoredvariable's value corresponds to a change in the chronic condition beingmonitored. Sometimes, however, this premise is incorrect. For example, apatient's weight may vary because the patient is experiencing an acuteepisode of pulmonary edema, in which case the premise is correct—thechange in the patient's weight over time reveals a change in the stateof the chronic condition. On the other hand, a patient's weight may varyover time because the patient has gained or lost fatty or musculartissue. Per such a scenario, the change in the patient's weight isunrelated to the chronic condition being monitored.

As mentioned above, in some instances an alert may be generated in theevent that the measured variable exceeds or falls short of a threshold.Such a strategy may prove unreliable in the situation where themonitored variable has exhibited change for reasons unrelated to thechronic condition being monitored. With respect to FIG. 39A, one mayassume, for the sake of illustration, that the measured variable is apatient's weight, and that each darkened dot on the Cartesian planerepresents a given daily weight measurement for a particular patient.Thus, point 3900 represents a particular patient's weight on a givenday, and point 3902 represents the patient's weight as measured on asuccessive day, and so on.

Examination of the graph of FIG. 39A reveals that on the day that thepoint 3904 was measured, the patient's weight exceeded an upper limitthreshold, meaning that the initial assessment process 3600 (FIG. 36)would have generated an alert or exception that day. In responsethereto, a verification process 3602 (FIG. 36) would have beeninitiated, and for the sake of illustrating the foregoing concepts, onemay assume that the verification would have turned out to be negative(i.e., an interview of the patient would reveal that the patient did notneed medical attention). As shown in FIG. 39A, a similar result wouldhave occurred for fourteen consecutive days.

After two weeks of generating an alert, and thereby initiating averification process, the software on the central computing system (orpatient monitoring device, if implemented thereupon) may be programmedto re-establish a new threshold, as shown in FIG. 39A. The premise forthe re-establishment is that the patient has simply gained weight, andis not experiencing edema, so the upper limit should be modified.

FIG. 39B depicts one method for altering a threshold. As shown therein,the process begins by determining whether, for a given monitoredparameter, that parameter has caused an alert during the assessmentprocess 3600 (FIG. 36), as shown in operation 3906. If so, control ispassed to operation 3908, whereupon it is determined whether thesubsequent verification process 3602 (FIG. 36) has shown the patient tonot be in need of medical assistance. If the answer to either of theseinquiries 3908 is in the negative, then control is passed to operation3910, whereupon a count variable is reset to zero, and the process ishalted (operation 3912). On the other hand, if the answer to both of theinquiries of operations 3906 and 3908 is in the affirmative, the countvariable is incremented (operation 3914), indicating that another dayhas transpired whereby a particular variable generated an alarm, but thepatient has proven to be in satisfactory condition.

In operation 3916, the count variable is compared against a threshold,which may be selectable. For example, the threshold may be equal tofourteen days, as shown in the example of FIG. 39A. If the countvariable exceeds the threshold, the threshold(s) against which thevariable is tested for generation of an alert may be adjusted (operation3918). Otherwise, the process is halted (operation 3920).

There exist many possibilities for adjusting such a threshold. Forexample, the software may be programmed to find a measure of centraltendency over a span of the preceding N days. Then, an offset variablemay be added (and/or subtracted) to the central tendency, to generate anew upper threshold and/or lower threshold. For example, in the contextof the graph of FIG. 39A, execution of operation 3918 may includefinding the average patient weight over the fourteen-day periodpreceding the measurement of point 3905. Then, an offset variable may beadded to the average value, creating an upper threshold limit, and anoffset value may be subtracted therefrom, yielding a lower thresholdlimit. Of course, other measures of central tendency may be used, suchas arithmetic mean, geometric mean, median, etc. Also, other schemes foradjusting a threshold on the basis of observed historical data mayreadily present themselves to ones of ordinary skill in the art, and arewithin the scope of the present invention.

Assessment of Questions

As described with reference to FIG. 36, the assessment and verificationprocesses consist, in large part, of analysis of a patient's answers toquestions. Consequently, the assessment and verification processes areonly as good as the questions that are asked. To ensure that informativequestions are asked, a system may be configured to ask a great multitudeof questions, in the hope that at least some of them will beinformative. On the other hand, such a strategy exhibits a drawback: thepatient tires of answering the great number of questions.

To address this issue, it may be desirable to have a tool by which togain insight into the effectiveness of a question with respect to itsability to predict the onset of a significant health care related event(e.g., hospitalization). FIG. 40A depicts a chart that provides theillustrating concepts upon which such a tool may function.

FIG. 40A depicts a Cartesian plane that presents data revealing theeffectiveness of a given question in predicting the onset of asignificant health care related event for a given patient population.The Cartesian plane has a plurality of darkened dots presented therein.Each darkened dot represents the percentage of the given patientpopulation answering the given question in the affirmative (measuredalong the y-axis) on a given day (measured along the x-axis). Thus,point 4000 represents the percentage of the patient populace answeringthe given question in the affirmative on a given day, and point 4002represents the percentage of the patient populace answering the givenquestion in the affirmative on a successive day.

A vertical dashed line on the chart represents the point in time atwhich the patient populace experienced a significant health care relatedevent. For the sake of illustration, the dashed line is referred toherein as representing a day on which each patient in the patientpopulace was hospitalized. Accordingly, the point 4004 preceding thedashed line represents the percentage of the patient populace answeringa question in the affirmative on the day preceding hospitalization.

As can be seen from FIG. 40A, for the given patient population measuredby the chart therein, the percentage of the patient populace answeringthe question in the affirmative on a given day increases dramatically inthe days immediately preceding hospitalization. It is therefore fair toconclude that the particular question corresponding to the chart of FIG.40A is an effective predictor for the particular patient population.According to one embodiment, the central computing system may beprogrammed to create and display a chart such as the one depicted inFIG. 40A.

FIG. 40B depicts an example of a method by which the effective of aquestion may be measured. The method begins with selection of variablesM and N, in operation 4006. N represents the number of points precedinghospitalization to be considered for formulation of statisticsdescribing a group to be assessed for effectiveness. M represents thenumber of points preceding the assessment group to be considered forformulation of statistics describing a control group. For example, ifN=7 and M=10, then operations 4008, 4010, and 4112 cooperate todetermine whether a given question appears to predict the onset ofhospitalization up to seven days prior thereto, when considered in lightof a control group of ten data immediately preceding points.

Next, in operation 4008, the mean and standard deviation of the set of Npoints and the set of M points are calculated. Thereafter, as shown inoperation 4010 the median of the set N of points is compared against themedian and standard deviation of the set of M points. If the median ofthe set of N point falls more than a given number of standard deviationsaway from the median of the set of M points, the question is deemed tohave significance, and the data may be recorded, as shown in operation4012. Thereafter, it is determined whether the analysis process iscomplete, as shown in operation 4014. If so, the process halts(operation 4016).

On the other hand, if the process is to continue, then N is adjusted(operation 4018), and control returns to operation 4008, and the processcontinues as described above.

Cooperation with Implanted Device

FIG. 41 depicts a patient monitoring device 4100 (such as the patientmonitoring devices 1100, 2100, or 3800 depicted in FIGS. 11, 21 or 38,respectively) that cooperates with an implanted device 4102. Forexample, the implanted device 4102 may be a cardiac rhythm managementdevice, such as a pacemaker, cardiodefibrillator, resynchronizationdevice, or congestive heart failure (CHF) device. Alternatively, theimplanted device 4102 may be any other implanted medical device, such abioimpedance measuring device, a transthoracic impedance measuringdevice, an infusion pump, etc. For the sake of discussion only, theimplanted device 4102 is depicted and discussed herein as being acardiac rhythm management device.

For the sake of generally orienting the reader regarding a cardiacrhythm management device, FIG. 42 depicts a simple exemplary embodimentof such a device. As can be seen from FIG. 42, a cardiac rhythmmanagement device 4102 typically includes a controller 4200 thatcontrols the device 4102. The controller 4200 may include amicroprocessor and various memory units, or may be embodied as anapplication-specific integrated circuit (ASIC). For example, thecontroller 4200 may include multiple memory units, such as a flashmemory in which firmware for controlling the operation of the device isstored, and a random access memory (RAM) into which various values withwhich the firmware interacts are stored. The RAM may store values thathave been measured by the device 4102, thereby developing a data set, asdiscussed below.

The controller 4200 is coupled to a channel system 4202, which isinterposed between the controller 4200 and a lead system 4208. The leadsystem 4208 is, in turn, coupled to a patient's heart 4210. The channelsystem 4202 serves as an interface between the controller 4200 and thelead system 4210.

The channel system 4202 may include a stimulation channel 4206 by whichthe controller 4200 may command the device 4102 to deliver a stimulationpulse to the heart 4210. Additionally, the channel system 4202 mayinclude a sense channel 4204 by which the controller 4200 may detect theelectrical activity of the heart 4210 (e.g., may detect depolarizationof the heart 4210, for example). The channel system 4202 may includemore than one sense and stimulation channel 4204 and 4206. For example,in the context of a dual-chamber device, the channel system may includeboth ventricular and atrial sense and stimulation channels.

According to one embodiment, the device of FIG. 42 measurestransthoracic impedance. By way of background, it is known that thoracicimpedance is inversely proportional to thoracic fluid volume, i.e.,pulmonary fluid. This inverse relationship exists because pulmonaryfluid is characterized by greater conductivity than the various tissuesthat otherwise fill the thorax. Thus, as thoracic fluid contentincreases, transthoracic impedance decreases. Accordingly, a reductionin transthoracic impedance may correspond to an increase in thoracicfluid content, which, in turn, may indicate impending decompensatedheart failure for a given patient.

According to one embodiment, the device 4102 of FIG. 42 measurestransthoracic impedance using the lead system 4208. For example, thedevice may include an impedance-measuring channel 4212 that communicatesinformation related to measured transthoracic impedance to thecontroller 4200. The impedance-measuring channel 4212 may be embodied asa separate channel, may be embodied as a part of the stimulation and/orsense channels 4204 and 4206, or may be embodied as a portion of achannel devoted to measuring respiration, for example.

As the cardiac rhythm management device 4102 operates, it generates adata set that characterizes various physiological aspects of thepatient, and describes the operation and/or response of the device 4102.For example, the device 4102 may periodically, or upon command, measurethe transthoracic impedance exhibited by the patient, and may store suchmeasurements. Optionally, the controller 4200 may calculate a long-termaverage and/or short-term average of the transthoracic impedanceexhibited by the patient over a period of time. The long-term averagemay be used as a reference point against which the short-term average iscompared, in order to determine whether the patient's transthoracicimpedance is abnormally depressed. The long-term average, short-termaverage, and each of the individual impedance measurements constitute aportion of the data set generated by the cardiac rhythm managementdevice, for example. Other elements of data may be present within thedata set developed by the device 4102. For example, the device 4102 ofFIG. 42 includes an accelerometer 4220, which generates a signal inproportion to its own acceleration. The accelerometer is coupled to thecontroller 4200 via a signal conditioning system 4222. The signalconditioning system 4222 is configured to filter the signal from theaccelerometer to yield frequencies within bands of interest, in light ofthe information to be gleaned from the accelerometer (of course, thesignal conditioning system 4222 may include an analog-to-digitalconverter and/or level shifters, etc., necessary for interface with thecontroller 4200). Thus, during operation, the accelerometer 4220 maydeliver information to the controller 4200 regarding the physicalactivity of the patient. According to one embodiment, the accelerometerinformation, or a portion thereof, or a value derived therefrom (such asone or more averages describing physical activity throughout variousportions of the day), is stored by the controller 4200. The storedaccelerometer information thereby becomes a part of the data setdeveloped by the device 4102. Furthermore, the accelerometer 4220 may beused to detect heart sounds present within a cardiac cycle. (In suchinstances, the accelerometer 4220 may be external to the device, and maybe located at the distal end of a lead within the lead system 4208.Alternatively, the device may include two accelerometers—an internalaccelerometer for detecting physical activity of the patient, and anexternal accelerometer for detecting heart sounds). Heart soundinformation, such as amplitude, shape, and/or frequency informationconcerning the S1, S2, S3, and/or S4 heart sounds may be stored and mayconstitute a portion of the data set developed by the device 4102. Stillfurther, as alluded to earlier, the device may measure transthoracicimpedance in order to obtain information concerning the patient'srespiration (e.g., rate, volume, etc.). (It is known that atransthoracic impedance signal contains information concerning thoracicfluid volume within its low frequency bands, and contains informationconcerning respiration in its relatively higher frequency bands. Thus,various filtering mechanisms may be employed to extract the informationof relevance, depending upon whether thoracic fluid volume orrespiration information is sought.) Information concerning the patient'srespiration throughout various periods of the day may also be stored asa part of the data set developed by the device 4102. Still further, itis known for a cardiac rhythm management device 4102 to generate eventmarkers that indicate the time and date on which the device 4102observed a particular cardiac rhythm abnormality. The event markers mayalso constitute a part of the data set developed by the device 4102.

The cardiac rhythm management device 4102 includes an input/output (I/O)channel 4214. The I/O channel 4214 establishes a communication link 4216with an external device 4218. The communication link 4216 may, forexample, be an RF link, such as an RF link according to the IEEE 802.11standards, may be an inductive link, or may be any other form ofsuitable link. The communication link 4216 permits the data setdeveloped by the device 4102 to be delivered to another device thatdevelops its own data set, whereupon the two data sets may be comingled,and whereupon the two data sets may be usefully analyzed for the purposeof extracting reliable predictive and/or diagnostic informationconcerning the patient (this is discussed at greater length, below).

Returning to FIG. 41, four examples of external devices 4218 with whichthe cardiac rhythm management device 4102 may communicate are depicted.For example, the cardiac rhythm management device 4102 may communicatewith the patient monitoring device 4100. Alternatively, it maycommunicate with a wireless device 4104, such as a personal digitalassistant (PDA) outfitted with a suitable communication interface tocommunicate with a wireless access point 4106. Thus, data communicatedfrom the cardiac rhythm management device may be relayed to a wirednetwork 4108, and may ultimately reach any device coupled to the network4108. Further, the cardiac rhythm management device 4102 may communicatewith a programmer 4110 (such as a programmer that is typically found ina doctor's office for the purpose of reprogramming and interrogating thecardiac rhythm management device 4102), which may, in turn, communicatethe data through a network 4108.

By virtue of communicating with an external device 4218 (such aswireless device 4104, patient monitoring device 4100, or programmer4110) that is coupled to a network 4108, the data set maintained by thecardiac rhythm management device 4102 may be comingled with the data setdeveloped by the patient monitoring device 4100. The data sets may becomingled in any of the devices 4100-4114 coupled (directly orindirectly) to the network 4108. According to one embodiment, the datasets are comingled by a server 4112 in data communication with a datastore 4114. The server 4112 may be accessed by health care professionalsthat provide medical services to a given patient. Thus, according to oneembodiment, the server 4112 includes a secure web server, that permitsretrieval of information stored within the data store 4114. According toanother embodiment, the data sets are initially comingled by the patientmonitoring device 4100. Per this embodiment, the patient monitoringdevice 4100 is configured to communicate with the cardiac rhythmmanagement device 4102, and can both read data therefrom (e.g., caninterrogate the device 4102), and can optionally write data thereto(e.g., may have complete or limited ability to program the device 4102).Upon commingling, the two data sets provide information from whichvarious medical conclusions about the patient may be drawn. For example,as discussed below, the two data sets jointly provide information thatmay reliably indicate and/or predict decompensation of heart failure.

As mentioned previously, the cardiac rhythm management device generatesa data set during its operation. According to one embodiment, the dataset generated thereby is constructed according to the method depicted inFIG. 43. As can be seen, from FIG. 43, the method of data setconstruction begins with the device acting according to its normaloperation, as shown in state 4300. Thereafter, an execution eventoccurs, which causes the device to transition to measurement state 4302(which is titled “Measure Impedance” for the sake of example, but refersto any measurement which might be taken by the device). The executionevent causing the state transition refers to any event appropriate toinitiate the taking of a measurement. The execution event may be, forexample, the occurrence of a specific time of day (e.g., a measurementis always taken at 3:00AM or 12:00 PM), or may be the detection or arhythm abnormality (e.g., the device detects the onset of atrial orventricular fibrillation, or detects a synchronization abnormalitybetween the various chambers of the heart). According to anotherembodiment, the execution event is a command from the patient monitoringapparatus, meaning that the patient monitoring apparatus commands thetaking of a measurement, such as an impedance measurement, therebycausing transition to state 4302. In instances in which a measurement issensitive to factors that may vary throughout the day (example:posture), it may be advantageous to have the measurement initiated bycommand of the patient. For example, thoracic impedance measurements areknown to be sensitive to, amongst other things, patient posture (thethoracic cavity tends to fill with fluid as a person reclines, meaningthat even a healthy person exhibits an impedance drop when reclining).Therefore, according to one embodiment, the patient monitoring device isfashioned as a scale, as depicted in FIGS. 1A-1E. The patient weighshimself, using the patient monitoring device, answers questions posed bythe device, and initiates measurement of transthoracic impedance (themeasurement is initiated by virtue of a command transmitted from thepatient monitoring apparatus to the device). At the time the measurementis initiated, the patient is known to be standing on the scale, meaningthat variability of transthoracic impedance known to occur from postureis eliminated. The device responds by taking the measurement, andstoring the measurement, as shown in state 4304. Thereafter, the devicereturns to normal operation state 4300.

Upon returning to normal operation state 4300, the device may bepartially or entirely interrogated by the patient monitoring apparatus.For example, the patient monitoring apparatus may request that onlyspecific data items be transmitted from the device to the apparatus(example: the apparatus may request that only impedance measurements betransmitted from the device to the monitoring apparatus). On the otherhand, the patient monitoring apparatus may request a completeinterrogation procedure, so as to read all of the data stored therein.In the wake of operation 4306, the data set generated by the cardiacrhythm management device is comingled with the data set generated by themonitoring apparatus within the memory of the apparatus. Uponcommingling of the data sets, significant conclusions regarding themedical status of the patient may be drawn. Prior to discussionregarding the drawing of conclusions, it should be noted that the datasets developed by the patient monitoring apparatus and the cardiacrhythm management device may commingle in any computing environmentdepicted in FIG. 41. Another point should be noted. It is within thescope of this disclosure to program any of the devices in FIG. 41 topose the questions, and/or to execute the methods disclosed herein. Forexample, the PDA 4104 may be programmed to pose the question setsdisclosed herein, and to implement the methods disclosed herein. Sincethe PDA lacks a scale, the PDA may simply prompt the patient to weighthimself, and to enter the measurement. On the other hand, the PDA maycontain an interface (example: RF interface to communicate with a scale)permitting communication with a scale. Weight measurements arecommunicated from the scale to the PDA through the communication link.Once completed, the PDA may travel with the patient, meaning the patientmay interact with his device through the PDA throughout the day, andthat the patient may answer questions through the PDA at any timethroughout the day (the questions may be created dynamically by healthcare professionals, as discussed with reference to the two-way messagingportions disclosed herein, for example).

At any of the devices having access to both the data set generated bythe cardiac rhythm management device and the data set generated by thepatient monitoring apparatus, the following conclusions may be drawn (itis understood that other conclusions may be drawn as well).

Transthoracic impedance tends to be an early indicator of decompensatedheart failure. However, as noted above, impedance measurements mayfalsely indicate the accumulation of heart failure for a variety ofreasons (example: if the measurements are taken with leads implanted inthe heart, the measurements may be subject to rhythmic physiologicalcycles, such as the cardiac rhythm and respiration cycle, the effects ofwhich may be only partially filtered out). On the other hand, patientweight is known to be another indicator of decompensated heart failure.Occasionally, a patient with decompensated heart failure does notexhibit a significant weight gain. (Initially, fluid within the patientis redistributed to lungs, meaning that in the early stages ofdecompensation the patient may exhibit no weight gain, even though fluidhas begun to accumulate in the lungs). Patient weight is also subject toinfluences other than the accumulation of thoracic fluid. A patientexhibiting both a decrease in thoracic impedance and a weight gain aremay be more reliably identified as being likely to experience imminentdecompensation of heart failure. Thus, any of the devices of FIG. 41 maybe programmed to look for both conditions, and to generate an alert whenboth conditions are present. On the other hand, an alert may begenerated when only a single measurement indicates the possibility ofdecompensation (e.g., only impedance is depressed, or only weight iselevated), but the patient's answers to the questions indicate symptomsconsistent with decompensation. Thus, any of the devices of FIG. 41 maybe programmed to identify an abnormal impedance or weight combined withanswers consistent with decompensation, and to generate an alert whenboth conditions are present.

Other combinations of data may be observed by any of the devices of FIG.41 to determine decompensation. For example, it is known that atrialfibrillation may be transitory (may last for only a few hours or a fewdays). If the atrial fibrillation is sufficiently short-lived, thepatient may exhibit no weight gain, even though the heart isdecompensating. However, the device may communicate the occurrence of anevent marker indicating the beginning of atrial fibrillation to thepatient monitoring apparatus. The patient monitoring apparatus may alsointerrogate the device to obtain the transthoracic impedance exhibitedby the patient. A decrease in impedance, combined with an atrialfibrillation marker may indicate that the patient is decompensating, andthat the patient should be seen. Thus, any of the devices of FIG. 41 maybe programmed to look for both conditions, and to generate an alert whenboth conditions are present. Further, the patient monitoring apparatusmay seek to verify its conclusions by identifying patients with answersconsistent with decompensation. Therefore, any of the devices of FIG. 41may be programmed to identify occurrences of atrial fibrillationmarkers, depressed transthoracic impedance, and patient answersconsistent with decompensation, and to generate an alert when theseconditions are present.

Acute coronary syndrome may be determinable from the combined data setsof the device and the patient monitoring apparatus. For example, thepatient monitoring apparatus may interrogate the device to obtainrecently stored records of heart sounds. The frequency/amplitude/shapeinformation within the heart sound data may be analyzed to determinethat a wall within the heart does not appear to be moving. Such aconclusion, combined with patient answers consistent with acute coronarysyndrome may be identified by any of the devices in FIG. 41, and analert may be generated in response to their occurrence.

Multiple User Management

A monitoring apparatus can be programmed to utilize an identifier todetermine which one person is currently using the apparatus, from amonga plurality of persons authorized to use the apparatus. In such anembodiment the monitoring unit is rendered usable by more than oneperson. Such an embodiment is particularly advantageous when themonitoring apparatus is placed in multi-user homes, in health clubs,work places, clinics, or other areas where multiple potential users ofsuch a system may congregate. As such, the monitoring apparatus canprovide a health care or monitoring access point, thereby allowingindividuals to transmit wellness parameters to a remote caregiver anddecrease the number and frequency of clinic visits.

The monitoring unit uses the identifier to determine the identity of theuser. The monitoring unit proceeds to execute on the basis of data thatis associated with the identifier. For example, the identifier maycontain a memory that contains both the identity of a patient as well asa listing of historical health data. Thus, for example, the monitoringunit monitors appropriate wellness parameters and asks appropriatequestions for the particular user, whether he or she be a person usingthe system for weight management, or to monitor disease parameters suchas blood glucose, weight, blood pressure, heart rate, or otherbiometric, symptom and health status parameters.

In one possible embodiment, the data representative of a particularuser's answers and wellness parameters can be transmitted to a remotecomputing system in association with the identifier. This permits theremote computing system to know whose data it has just received. Inembodiments where the identifier includes a memory, the data can betransmitted to be stored on the identifier itself.

In various embodiments, the identifier may be encoded upon a magneticstrip, upon an infrared signal, or upon a radio frequency signal.

Referring now to FIG. 44, a multiuser wellness parameter monitoringsystem 4400 is shown according to a possible embodiment of the presentdisclosure. In general, the system 4400 is configured to monitor one ormore wellness parameters of patients by allowing multiple patients 4402to use a single monitoring apparatus 4404. The system 4400 is designedto monitor multiple patients 4402. To accomplish this task, the system4400 must be able to identify a patient 4402 from among a group ofpatients allowed to use the system.

The system includes a plurality of monitoring apparatus 4404 operativelyconnected to a remote computer 4406. Each monitoring apparatus 4404coordinates with a patient identifier 4408 that is unique to the patient4402. The patient identifier 4408 that can be used by the monitoringapparatus 4404 can be any indicator that is unique to the patient. Invarious embodiments, the patient identifier 4408 can be a smart card orother card including a magnetic strip, wireless communication component,or bar code. In further embodiments, the patient identifier 4408 can bean RFID tag, a biometric identifier unique to a patient 4402, or analphanumeric password system. The monitoring apparatus 4404 generallywill include a patient identification device that corresponds to thedesired patient identifier 4408, such as those described below inconjunction with FIG. 45.

Information regarding whether certain patients are allowed to use thesystem can be recorded in a database resident on either the monitoringapparatus 4404 or the remote computer 4406. Furthermore, measurementsand responses to queries could be associated with the patient in theapparatus and sent to the remote computer 4406. By storing patientrecords on the remote computer, the patient 4402 can use any of themonitoring apparatus 4404 and be recognized by the system 4400.

A website may be provided as an access point to allow the person usingthe monitoring unit (or another designated person such as a health careprovider, spouse, or parent) to access information collected by themonitoring unit. For example, the website may be hosted at least in partby the remote computer, and can allow access to a database that storesinformation collected by the monitoring apparatus. In the embodimentshown, one or more workstations 4410 can be networked to the remotecomputer 4406. The person can use the workstations 4410 to gain accessto the information in the database by entering the identifier, which isan indication uniquely associated with the particular person, such asthe patient identifiers listed above. The database is accessed basedupon the identifier, and one or more webpages are then presented to theperson. The webpages may include indications of the person's weight lossprogress (as discussed above), health history (such as has beendiscussed above), historical symptoms experienced (discussed above), ormay present any of the other information presented on the screen shownin the preceding Figures. Alternatively, this data may be communicatedfrom the monitoring unit or remote computer to a device such as apalm-top computer, a television set, or a telephone (e.g., via a modem)for presentation to a designated person. Of course, the same websiteinformation can be accessed, for example, on the monitoring apparatus byusing a display 4531 or other output device as shown 4530, 4533 in FIG.45.

Referring now to FIG. 45, a functional block diagram of monitoringcircuitry 4500 is shown, forming an environment in which possibleembodiments of the monitoring apparatus of the present disclosure may beemployed. The embodiment of system 4500 as shown incorporates a patientidentification device 4502. The patient identification device 4502 isconfigured to determine if a person trying to use the system is one whois among a plurality of patients that are allowed to use the system4500. The device 4502 selects one patient from among a plurality ofpatients that are allowed to use the system 4500.

The patient identification device 4502 can select the patient byinterfacing with an identifier 4504. The identifier 4504 can be one ormore of the identifiers described above in conjunction with FIG. 34 thatcorrespond to the patient identification device 4502 resident in thesystem 4500. In embodiments where the identifier incorporates a memory,the patient identification device 4502 includes an interface to thememory, allowing the system 4500 to read or write data to theidentifier.

In use, the system 4500 measures one or more wellness parametersconsistent with the disclosure herein. For example, the system couldmeasure the weight of the patient. By detecting the identity of thepatient, the weight measurement can be associated with theidentification of the patient, allowing multiple patients to use thesame system without the system detecting weight variations betweenpatients to be alert conditions.

The patient identification device 4502 can be any of a number of devicesconfigured to interface with a selected patient identifier 4504. In apreferred embodiment, the patient identification device 4502 is a smartcard reader, as shown below in conjunction with FIG. 47. The smart cardreader can be any type of card reader, from a magnetic strip reader, toa short range wireless transceiver, to a bar code reader. The patientidentification device 4502 can also be, for example, an RFIDtransceiver, a password authentication system, or a biometric sensorsuch as a fingerprint reader or voice recognition system. In oneparticular embodiment below, the patient identification device 4502 isan ISO 7816 smart card reader incorporating a RS-232 interface chipmanufactured by Microchip Technology, Inc. The needed firmware forcontrolling such a system can be incorporated in the memory 40 residentin the system 4500.

A smart card is generally understood to be any pocket-sized card withembedded integrated circuits. Such cards can include memory andprocessing capabilities. Memory cards contain only non-volatile memorystorage components, and perhaps some specific security logic.Microprocessor cards contain memory and microprocessor components. Smartcards are generally cards of credit card dimensions that are oftentamper-resistant. Smart cards include contact (magnetic strip orinterface) and contactless (generally RFID) smart cards.

Various alternate embodiments of the microprocessor system 4500 caninclude the patient identification device, such as the systems describedabove in conjunction with FIGS. 4-6. For example, the system 4500 caninclude the patient identification device 4502 in systems incorporatinga wide variety of physiological parameter transducing devices, such asthe analog scale or digital scale described above. Other physiologicalparameters that could be measured using similar systems and associatedwith a patient include weight, blood glucose, blood oxygen level, bloodpressure, transthoracic impedance (examples of measured variables), ormay be a score describing a patient's self-reported symptoms.

It is noted that for simplicity of design, a single type of patientidentification device is used in conjunction with a single type ofpatient identifier in the embodiment described. However, it isrecognized that additional types of patient identification devices canbe used in conjunction with multiple patient identifiers in order toprovide redundancy. This may be advantageous in situations where apatient loses an identification card, forgets a password, or otherwiseis unable to use the primary mode of identification in the system 4500.

As shown microprocessor system 4524 including a CPU 4538, a memory 4540,an optional input/output (I/O) controller 4542 and a bus controller 4544is illustrated. The microprocessor system 4524 can be used, for example,in systems such as those described below in conjunction with FIGS.47-48. It will be appreciated that the microprocessor system 4524 isavailable in a wide variety of configurations and is based on CPU chipssuch as the Intel, Motorola or Microchip PIC family of microprocessorsor microcontrollers.

Microprocessor system 4524 can be interfaced with a transducing device4518. Transducing device can be any of a number of physiologicalparameter transducers. For example, transducing device 4518 could be adigital or analog scale 18, as shown above in conjunction with FIGS.4-6. In further embodiments, transducing device 4518 could be a bloodpressure cuff or pulse oximeter as described below in conjunction withFIG. 48. Additional embodiments of transducing device 4518 may include aglucometer, spirometer, or other typical monitors. It is noted that thetype of transducing device 4518 is not germane to the presentdisclosure.

It will be appreciated by those skilled in the art that the monitoringapparatus requires an electrical power source 4519 to operate. As such,the monitoring apparatus may be powered by: ordinary household A/C linepower, DC batteries or rechargeable batteries. Power source 4519provides electrical power to the housing for operating the electronicdevices.

The housing 4514 includes a microprocessor system 4524, an electronicreceiver/transmitter communication device 4536, an input device 4528 andan output device 4530. The communication device 4536 is operativelycoupled to the microprocessor system 4524 via the electronic bus 4546,and to a remote computer 4532 via a communication network 4534 andcommunication device 4535. The communication network 4534 being anycommunication network such as a telephone network, wide area network, orInternet. It will be appreciated that the communication device 4536 canbe a generally known wired or wireless communication device. Forexample, the device 4536 can be any packet-based or wave-based wirelesscommunication device operating using any of a number of transmissionprotocols, such as 802.11a/b/g, Bluetooth, RF, cellular (CDMA or GSM) orother wireless configurations. The device can alternately oradditionally incorporate a wired device, such as a modem or other wiredinternet connection.

It will be appreciated that output device(s) 4530 may be interfaced withthe microprocessor system 24. These output devices 4530 include a visualelectronic display device 4531 and/or a synthetic speech device 4533.Electronic display devices 4531 are well known in the art and areavailable in a variety of technologies such as vacuum fluorescent,liquid crystal or Light Emitting Diode (LED). The patient readsalphanumeric data as it scrolls on the electronic display device 4531.Output devices 4530 include a synthetic speech output device 4533 suchas a Chipcorder manufactured by ISD (part No. 4003). Still, other outputdevices 4530 include pacemaker data input devices, drug infusion pumps,or transformer coupled transmitters.

It will be appreciated that input device(s) 4528 may be interfaced withthe microprocessor system 4524. In one embodiment of the invention anelectronic keypad 4529 is provided for the patient to enter responsesinto the monitoring apparatus. Patient data entered through theelectronic keypad 4529 may be scrolled on the electronic display 4531 orplayed back on the synthetic speech device 4533.

The microprocessor system 4524 is operatively coupled to thecommunication device 4536, the input device(s) 4528 and the outputdevice(s) 4530.

Referring now to FIG. 46, systems 4600 for multiuser wellness parametermonitoring are shown according to a possible embodiment of the presentdisclosure. The system 4600 as shown is configured to associate queriesand physical wellness parameter measurements with a unique patientidentifier, allowing the system to take such measurements from multipleusers for each physical instance of the system. The system 4600 isinstantiated with a start operation 4602.

After the start operation, operational flow passes to an identify module4604. The identify module 4604 is configured to identify a patient, suchas a patient accessing the system 4600. The patient can provide anidentifier to the system 4600 as described above in conjunction withFIGS. 44-45. The identify operation 4604 determines which patient iscurrently attempting to use the system 4600 from among a plurality ofpatients authorized to do so. The identify module 4604 can accessrecords located within the system, stored on the identifier, or canaccess records stored remotely from the system, such as in a remotedatabase in a remote computing system as seen in FIGS. 44-45.

Operational flow can next pass to a receive module 4606. The receivemodule 4606 is configured to accept information sent to the system 4600,such as from a remote computer or a patient identifier. The informationsent to the system 4600 may include information about the patientidentified in the identify module 4604, and can include personalidentification information, medical history information, symptomidentifier information, or queries to be posed to the patient related topossible symptoms that he/she may be experiencing.

The system 4600 further includes a determine wellness module 4608, towhich operational flow can be passed after the receive module 4606. Thedetermine wellness module 4608 is configured to measure a wellnessparameter of the patient, which may include the patient's weight, bloodpressure, blood sugar level, heart rate, blood oxygen level, or anyother wellness parameter described herein. The wellness parameter can beany of a number of wellness parameters as previously described.

The system further includes a query module 4610. The query module 4610is configured to present one or more queries to the patient. The queriescan be a number of preset queries or can be a number of queries tailoredto the identified patient. One or more queries are stored on amonitoring apparatus, such as the one shown in FIGS. 34-35. One or morequeries may also be stored on a remote computer as shown in FIG. 34. Thequeries are related to one or more symptoms that the patient may beexperiencing, such as the questions described above in conjunction withFIGS. 22-26.

In further exemplary embodiments of the present invention, the querymodule could ask a variety of questions related to a patient's healthhistory, economic and/or living circumstances, quality of life, riskstratification assessments, work conditions or other environmental orhereditary factors. In this way, the system 4600 can identify healthrisk exposures of patients and tailor later diagnostic questions inaccordance with such a system.

In certain embodiments of the present invention, the query module isemployed as a multiple day, multiple communication session questioncustomization scheme such as is described above in conjunction withFIGS. 16-18. In another embodiment, the query module is configured forreal-time communication of questions between the caregiver and thepatient.

After or concurrent with the query module 4610, operational flow ispassed to an input module 4612. The input module 4612 is configured toaccept answers from the patient in response to the queries posed. Theinput module 4612 can accept a response in a number of formats, such asby voice recognition or by entry using a numeric or answer keypad.

After the input module 4612, operational flow is passed to a send module4614. The send module 4614 is configured to associate all of the data(the responses to queries and determination of wellness parameters)collected by the monitoring apparatus with the patient and send the datato a remote computer. The send module can be implemented, for example,over a communication network such as described above. Based on the datasent during the send module 4614, a remote computer that receives thedata may issue an alert or exception to a caregiver, signifying that aphysiological abnormality has been detected or that an input provided inresponse to a query signifies a need for follow-up medical attentionfrom a caregiver. Such an alert can be generated in accordance with anyof the methods described herein, such as scoring, comparison anddetection of variance from past data, or other caregiver presetcriteria.

Operational flow of the system 4600 is terminated at an end operation4616.

In use, a single system 4600 can be placed at a doctor's clinic, atwhich one or more patients can have measured one or more physicalwellness parameters as described herein. The patient can provide aunique identifier, allowing the system 4600 to identify that patient andassociate the wellness parameter determination and responses to thequeries acquired in modules 4608, 4610 with the patient identified inthe identify module 4604. This information can be grouped and sent to aremote computer in the send module 4614. If an alert or exception isissued by the remote computer, a caregiver can then provide instructionsto the patient via the remote computer and monitoring apparatus eitherat that time via a real-time communications link (i.e. instantmessaging, telephony, or other similar real-time construct) or at alater time based on stored messages in the remote computer. Such a linkcan use, for example, the communication network 4534 of FIG. 45.

Referring now to FIGS. 47-48, two possible physical structures ofmonitoring apparatus 4700, 4800 are shown. These apparatus are small,portable devices that are configured to be placed in a wide variety ofhealthcare related and non-healthcare related locations in order tofacilitate patient interaction and health history tracking on a largepopulation without having to outfit each potential patient with such anapparatus. Specifically, the apparatus 4700, 4800 can be placed in aworkplace to ensure regular monitoring, leading to potential earlyintervention regarding potential health issues of workers. The apparatus4700, 4800 could be configured with a scale and placed in a health club,allowing the apparatus to be used as a personalized weight managementsystem as described above in conjunction with FIGS. 29-35.

Referring now to FIG. 47, a physical structure of a monitoring apparatus4700 is shown according to one possible embodiment. In the embodimentshown, the monitoring apparatus 4700 has a body 4702 that incorporates apersonal identification device 4704 and a panel 4706 incorporating inputdevices and output devices.

The personal identification device 4704 can be any of a number ofidentification devices as described above in conjunction with FIG. 45.In the embodiment shown, the device 4704 includes an ISO 7816 standardsmart card reader interfaced to the circuitry as shown in FIG. 45through a USB or RS-232 interface chip, such as are manufactured byMicrochip Technologies, Inc.

The panel 4706 can incorporate input and output devices as shown in FIG.45 and described above in conjunction with FIGS. 4-6.

In use, a patient would activate the monitoring apparatus 4700 bysliding a smart card into the personal identification device 4704 shown.The apparatus 4700 would then determine if the patient is a recognizeduser by either accessing internal memory, data stored on the smart card,or a remote memory connected to the apparatus 4700 over a communicationnetwork.

In the embodiment shown, the monitoring apparatus 4700 can incorporate aphysiological parameter transducing device (not shown), or canalternately include linkages to such devices.

Referring now to FIG. 48, a possible structural embodiment of themultiuser wellness parameter monitoring apparatus 4800 is shown. In thisembodiment, the apparatus 4800 can be used as a “kiosk” placed in avariety of locations at which persons may congregate and either requireor be interested in a heath status update. The apparatus 4800 has a body4802 that incorporates a personal identification device 4804 and a panel4806 incorporating input devices and output devices. In the embodimentshown, the body 4802 is rounded and includes molded forms that can holdphysiological parameter transducing devices, such as pulse oximeter 4808and blood pressure cuff 4810.

Pulse oximeter 4808 can be any of a number of widely available oximeterproducts on the market. Such pulse oximeters 4808 can measure thepatient's heart rate and/or blood oxygen level. Blood pressure cuff 4810can be any of a number of blood pressure cuffs widely available as well.Of course, any number of additional physiological parameter transducingdevices could be integrated with the apparatus 4800 consistent with thepresent disclosure.

Referring now to FIG. 49, aspects of a multiuser wellness parametermonitoring system 4900 are shown according to a possible embodiment ofthe present disclosure. The system includes a central computer 4902networked to a plurality of remote caregiver workstations 4804 and aplurality of monitoring apparatus 4906.

The central computer is a generalized computing system, and can includea database 4908. The central computer 4902 stores data regarding aplurality of monitored patients. The data is received from themonitoring apparatus 4906 and stored in the database 4908. The database4908 on the central computer is accessible to the plurality of remotecaregiver workstations 4904.

The plurality of monitoring apparatus 4906 can be any of a number ofwellness parameter monitoring units located at clinics or in homes foruse by patients. The monitoring apparatus 4906 are interfaced with thecentral computer 4902, and send information about monitored patients tothe central computer to be stored in the database resident thereon. Theworkstations 4904 in turn can access the information in the database4908 on the central computer 4902.

The remote caregiver workstations 4904 as shown are typical computingsystems having a keyboard, mouse, and data storage. The workstations4904 are used by a plurality of caregivers 4910 to access the database4908 and monitor the plurality of patients using the monitoringapparatus 4906.

The workstations 4904 include or are interfaced to a caregiverauthentication system 4912. The caregiver authentication system 4912 isconfigured to identify one caregiver 4910 from among a plurality ofcaregivers authorized to use the workstations 4904. Such a system can beused in configurations of the system 4900 where the workstations 4904are located in a hospital or clinic. In such a situation, multiplecaregivers 4910 can have access to a single workstation 4904. It may benecessary to distinguish between caregivers due to varying access levelsor abilities to prescribe changes to the patients' monitoring routine.For example, the system 4900 may be configured such that only a doctorcan change the queries sent to the patient, so doctors must have aseparate access level from other caregivers also using the workstation4904.

The caregiver authentication system 4912 can include both hardware andsoftware. In various embodiments, the caregiver authentication system4912 could include an identification card reader, an RFID transceiver, abiometric sensor, or a password authentication system. In these variousembodiments, the system 4900 is configured to recognize a uniqueidentifier of the caregiver 4910 with the selected caregiverauthentication system 4912.

In various embodiments, the system 4900 can be used in conjunction withthe system 4400 of FIG. 34, with the central computer 4902 also actingas or networked with the remote computer 4406.

FIG. 50 is a block diagram illustrating an example implementation of apatient monitoring device 5000. Patient monitoring device 5000 may be amonitoring apparatus such as integrated monitoring apparatus 10 in FIGS.1A-1E, patient monitoring apparatus 1100 in FIG. 11, scale 1900 in FIG.19, monitoring apparatuses 4404 in FIG. 44, monitoring apparatus 4700 inFIG. 47, monitoring apparatus 4800 in FIG. 48, or another type ofpatient monitoring apparatus.

As illustrated in the example of FIG. 50, patient monitoring device 5000comprises a persistent storage medium 5002, a processor 5004, a randomaccess memory 5006, an input/output controller 5008 (“I/O controller5008”), a network interface 5010, a program memory 5012, and a bus 5014.Patient monitoring device 5000 may include many other components inaddition to the components shown in the example of FIG. 50. Forinstance, patient monitoring device 5000 may include one or moreadditional processors, a power conditioning and distribution unit, andother components.

In the example of FIG. 50, persistent storage medium 5002 may be a datastorage medium that is capable of storing data even when electricalpower to persistent storage medium 5002 is suspended. In other words,persistent storage medium 5002 is capable of persistently storing data.Persistent storage medium 5002 may assume a variety of different formsincluding one or more: hard disks, magnetic data storage tapes, flashmemory units, electrically-erasable programmable read-only memory(EEPROM), or other types of persistent storage media.

Processor 5004 is an integrated circuit that is capable of executingcomputer-executable instructions. The instructions may be formatted in avariety of different instruction sets. For example, processor 5004 maybe an integrated circuit that is capable of executingcomputer-executable instructions belonging to an x86 instruction set, anintegrated circuit that is capable of executing computer-executableinstructions belonging to a PowerPC instruction set, or anotherinstruction set. Furthermore, processor 5004 may be a variety ofdifferent types of integrated circuit including one or moremicroprocessors, application specific integrated circuits, digitalsignal processors, or other types of integrated circuits.

Random access memory 5006 comprises one or more volatile computer memoryunits that are capable of temporarily storing programs and data. Forinstance, random access memory 5006 may comprise one or more dynamicrandom access memory (DRAM) units, synchronous dynamic random accessmemory (SDRAM) units, Rambus memory units, double data rate (DDR) SDRAMunits, zero capacitor RAM units, twin transistor RAM units, and/or othertypes of volatile computer memory units.

I/O controller 5008 is an integrated circuit that is capable ofcontrolling peripheral input devices and output devices. I/O controller5008 may be capable of controlling a wide variety of different types ofinput devices and output devices. For example, I/O controller 5008 maybe capable of controlling a display screen, a sound system, atouch-sensitive display screen, a keyboard, a mouse, a touchpad, anarray of buttons, and/or other types of input devices or output devices.

Network interface 5010 is a network interface card that enables patientmonitoring device 5000 to communicate on a network 5030. Networkinterface 5010 may be a variety of different types of network interfaceand network 5030 may be a variety of different types of network. Forinstance, network interface 5010 may be an Ethernet adapter, atoken-ring interface, a WiFi interface, a WiMax interface, or anothertype of wired or wireless network interface. Network 5030 may be anEthernet network, a local area network, a wide area network, ametropolitan area network, an integrated services digital network, aplain old telephone service network, a cellular telephone network, theInternet, a virtual private network, or another type of network. Network50 may include one or more wired or wireless links.

Program memory 5012 is a non-volatile memory unit that is capable ofpersistently storing computer-executable instructions and data. Programmemory 5012 may be many different types of memory, includingprogrammable read-only memory, EEPROM, flash memory, and/or other typesof ROM.

Bus 5014 facilitates communication between persistent storage medium5002, processor 5004, random access memory 5006, I/O controller 5008,network interface 5010, and program memory 5012. Bus 5014 may compriseone or more different types of buses including parallel and serialbuses.

As illustrated in the example of FIG. 50, program memory 5012persistently stores a set of firmware 5016. Firmware 5016 includes a setof computer-executable instructions. The computer-executableinstructions of firmware 5016 may be subdivided into subsets ofcomputer-executable instructions. As illustrated in the example of FIG.50, the computer-executable instructions of firmware 5016 are subdividedinto a start-up module 5018, a dataset download module 5020, a datasetpresentation module 5022, a response reception module 5024, and aresponse upload module 5026.

When patient monitoring device 5000 starts up, processor 5004 executesinstructions in start-up module 5018. When processor 5004 executesinstructions in start-up module 5018, the instructions in start-upmodule 5018 cause patient monitoring device 5000 to initiate a patientmonitoring session with a patient who is being monitored by patientmonitoring device 5000. When patient monitoring device 5000 initiates apatient monitoring session, patient monitoring device 5000 may wait forthe patient to access patient monitoring device 5000, display a welcomescreen to the patient, perform a patient identification routine, andperform other preliminary operations.

After the instructions in start-up module 5018 cause patient monitoringdevice 5000 to initiate the patient monitoring session, processor 5004may execute instructions in dataset download module 5020. When processor5004 executes instructions in dataset download module 5020, theinstructions cause patient monitoring device 5000 to download a datasetfrom a monitoring server 5028 via network 5030.

The dataset may contain one or more prompts. The prompts in a datasetmay include questions for the patient, statements that request a patientresponse, requests for the patient to utilize a device that measures aphysiological characteristic of the patient (e.g., a scale to measurethe weight of the patient, an electrode to measure intrathoracicimpedance of the patient, a heart rate meter to measure the heart rateof the patient, etc.), and other types of prompts. In addition, theprompts in a dataset may include sets of instructions that causeprocessor 5004 to execute instructions stored in firmware 5016 thatcause patient monitoring device 5000 to automatically gather aphysiological characteristic of a patient from a sensor. Example sensorsmay include scales, heart monitors, blood pressure monitors, and so on.

The instructions in dataset download module 5020 may cause patientmonitoring device 5000 to download the dataset in a variety of ways. Forexample, the instructions in dataset download module 5020 may causeprocessor 5004 to instruct network interface 5010 to output a HypertextTransfer Protocol (HTTP) request to monitoring server 5028 for a datasetthat includes one or more prompts. Furthermore, in this example, theinstructions in dataset download module 5020 may cause network interface5010 to receive one or more HTTP responses that contain the dataset. Thedataset may be formatted in a variety of ways. For instance, a datasetmay be formatted as an extensible markup language (XML) document. Inanother instance, a dataset may be formatted as a Hypertext MarkupLanguage (HTML) document. Other formats may include Java files,spreadsheet files, bitmap files, JPEG files, image files, and otherformats.

The instructions in dataset download module 5020 may cause the receiveddataset to be stored in persistent storage medium 5002. For purposes ofexplanation, FIG. 50 shows a plurality of datasets 5003A through 5003N(collectively, “datasets 5003”) stored in persistent storage medium5002. In other implementations, dataset download module 5020 may causerandom access memory 5006 to store one or more datasets.

When persistent storage medium 5002 stores one or more datasets,processor 5004 may execute instructions in data presentation module5022. When processor 5004 executes instructions in data presentationmodule 5022, the instructions cause patient monitoring device 5000 topresent one or more prompts in a dataset stored in patient monitoringdevice 5000. The instructions in data presentation module 5022 may causepatient monitoring device 5000 to present the prompts in many differentways. For example, when processor 5004 executes the instructions in datapresentation module 5022, processor 5004 may read a prompt in a datasetstored in persistent storage medium 5002 and then instruct I/Ocontroller 5008 to cause a monitor to display the prompt.

Upon execution by processor 5004, instructions in response receptionmodule 5024 cause patient monitoring device 5000 to receive thepatient's response to a prompt presented by patient monitoring device5000. For example, when processor 5004 executes instructions in responsereception module 5024, the instructions may cause processor 5004 toinstruct I/O controller 5008 to receive the patient's response to aprompt via an input device. Furthermore, in this example, theinstructions of response reception module 5024 may cause processor 5004to store the response in random access memory 5006. A response to aprompt may assume many different forms. For instance, a response to aquestion-type prompt may be a yes or no answer. In another instance, aresponse to a prompt that requests the patent attach an electrode to thepatient's chest may be a value in Ohms that indicates the patient'sintrathoracic impedance.

After processor 5004 executes the instructions in response receptionmodule 5024, processor 5004 may execute the instructions in responseupload module 5026. Execution of the instructions in response uploadmodule 5026 by processor 5004 causes patient monitoring device 5000 toupload one or more of the patient's responses to monitoring server 5028.For example, the instructions of response upload module 5026 may causeprocessor 5004 to determine whether patient monitoring device 5000 hasreceived responses to all of the prompts in a dataset. In this example,if patient monitoring device 5000 has received responses to all of theprompts in the dataset, the instructions of response upload module 5026may cause processor 5004 to generate an XML document that encodes theresponses, and then instruct network interface 5010 to send the XMLdocument to monitoring server 5028. After monitoring server 5028receives the responses, an automated process or a health careprofessional may use the responses to evaluate a health and/or weightstatus of the patient.

Instructions in firmware 5016 may repeatedly cause patient monitoringdevice 5000 to download prompts, present prompts, receive responses, andupload responses. For instance, the instructions in firmware 5016 maycause patient monitoring device 5000 to perform a cycle of downloadingdatasets, presenting prompts, receiving responses, and uploadingresponses on a recurring (e.g., daily, monthly, etc.) basis. During sucha cycle, the instructions in firmware 5016 do not change. In otherwords, after patient monitoring device 5000 finishes executing theinstructions in firmware 5016 that cause patient monitoring device 5000to perform this cycle, the instructions in firmware 5016 are the same(i.e., are unaltered) as before patient monitoring device 5000 executedthe instructions in firmware 5016. In another example, the instructionsin firmware 5016 may cause patient monitoring device 5000 to perform thecycle when monitoring server 5028 begins sending a dataset to patientmonitoring device 5000. In other words, the instructions in firmware5016 may enable monitoring server 5028 to “push” datasets to patientmonitoring device 5000.

FIG. 51 is a flowchart illustrating an example operation of patientmonitoring device 5000 illustrated in the example of FIG. 50. Initially,processor 5004 executes instructions of start-up module 5018 that causepatient monitoring device 5000 to initiate a patient monitoring session(5100). Next, processor 5004 executes instructions of dataset downloadmodule 5020 that cause patient monitoring device 5000 to download one ormore datasets (5102). After the instructions of dataset download module5020 cause patient monitoring device 5000 to download a dataset, theinstructions of dataset download module 5020 cause patient monitoringdevice 5000 to store the received dataset (5104). In someimplementations, patient monitoring device 5000 may store the receiveddataset in persistent storage medium 5002. In other implementations,patient monitoring device 5000 may store the received dataset in randomaccess memory 5006.

After the instructions of dataset download module 5020 cause patientmonitoring device 5000 to store the dataset, processor 5004 executesinstructions of data presentation module 5022 that cause patientmonitoring device 5000 to read a prompt in the stored dataset (5106).Next, processor 5004 executes instructions of data presentation module5022 that cause patient monitoring device 5000 to present the prompt(5108). Subsequently, processor 5004 executes instructions of responsereception module 5024 that cause patient monitoring device 5000 toreceive a response to the presented prompt (5110).

Processor 5004 may then execute instructions of response upload module5026 that cause patient monitoring device 5000 to determine whetherthere are any additional prompts in the dataset that have yet to bepresented (5112). If there are additional prompts in the dataset thathave yet to be presented (“YES” of 5112), processor 5004 may executeinstructions of data presentation module 5022 that cause patientmonitoring device 5000 to read an additional prompt in the storeddataset (5106), and so on. On the other hand, if there are no additionalprompts in the dataset that have yet to be presented (“NO” of 5112),processor 5004 may execute instructions of response upload module 5026that cause patient monitoring device 5000 to upload responses to promptsin the dataset to monitoring server 5028 (5114). It should beappreciated that in other implementations, the instructions of responseupload module 5026 may cause patient monitoring device 5000 to uploadresponses to prompts in the dataset to a server other than monitoringserver 5028.

After processor 5004 executes the instructions that cause patientmonitoring device 5000 to upload the response to the prompts in thedataset to monitoring server 5028, processor 5004 may executeinstructions of start-up module 5018 that cause patient monitoringdevice 5000 to terminate the patient monitoring session (5116).Subsequently, processor 5004 may execute the instructions of start-upmodule 5018 that cause patient monitoring device 5000 to initiate a newpatient monitoring session (5100) and the cycle may start again.

FIG. 52 is a flowchart illustrating a second example operation ofexample patient monitoring device 5000. The example operationillustrated in FIG. 52 may be relatively advantageous in situations inwhich patient monitoring device 5000 pays for access to network 5030 ona per-transaction basis.

Initially, processor 5004 executes instructions of start-up module 5018that cause patient monitoring device 5000 to initiate a patientmonitoring session (5200). Next, processor 5004 executes instructions ofdata presentation module 5022 that cause patient monitoring device 5000to retrieve a prompt in a dataset stored in random access memory 5006(5202). Next, processor 5004 executes instructions of data presentationmodule 5022 that cause patient monitoring device 5000 to present theprompt (5204). Subsequently, processor 5004 executes instructions ofresponse reception module 5024 that cause patient monitoring device 5000to receive a response to the presented prompt (5206). Processor 5004 maythen execute instruction of response reception module 5024 that causepatient monitoring device 5000 to store the response in random accessmemory 5006 (5208).

Next, processor 5004 may execute instructions of response upload module5026 that cause patient monitoring device 5000 to determine whetherthere are any additional prompts in the dataset that have yet to bepresented (5210). If there are additional prompts in the dataset thathave yet to be presented (“YES” of 5210), processor 5004 may executeinstructions of data presentation module 5022 that cause patientmonitoring device 5000 to retrieve an additional prompt in the storeddataset (5202), and so on.

On the other hand, if there are no additional prompts in the datasetthat have yet to be presented (“NO” of 5210), processor 5004 may executeinstructions of response upload module 5026 that cause patientmonitoring device 5000 to initiate a network connection with monitoringserver 5028 (5212). Processor 5004 may then execute instructions ofresponse upload module 5026 that cause patient monitoring device 5000 toupload the responses to the prompts in the dataset (5214). Next,processor 5004 may execute instructions of dataset download module 5020that cause patient monitoring device 5000 to download one or moredatasets (5216). Processor 5004 may then execute instructions of datasetdownload module 5020 that cause patient monitoring device 5000 todisconnect from monitoring server 5028 (5218). After patient monitoringdevice 5000 disconnects from monitoring server 5028, processor 5004 mayexecute instructions of dataset download module 5020 that cause patientmonitoring device 5000 to store the one or more downloaded datasets(5220). In some implementations, patient monitoring device 5000 maystore the received dataset in persistent storage medium 5002. In otherimplementations, patient monitoring device 5000 may store the receiveddataset in random access memory 5006. Processor 5004 may then terminatethe patient monitoring session (5222).

FIG. 53 is a flowchart illustrating a third example operation of patientmonitoring device 5000. The example operation illustrated in FIG. 53 maybe relatively advantageous in situations in which patient monitoringdevice 5000 has unlimited access to network 5030.

Initially, processor 5004 executes instructions of start-up module 5018that cause patient monitoring device 5000 to initiate a patientmonitoring session (5300). Next, processor 5004 executes instructions ofdataset download module 5020 that cause patient monitoring device 5000to initiate a network connection to monitoring server 5028 (5302).Processor 5004 may then execute instructions of dataset download module5020 that cause patient monitoring device 5000 to download a prompt(5304). After patient monitoring device 5000 downloads the prompt,processor 5004 may execute instructions of data presentation module 5022that cause patient monitoring device 5000 to present the prompt (5306).Next, processor 5004 executes instructions of response reception module5024 that cause patient monitoring device 5000 to receive a responsefrom the user to the presented prompt (5308). After patient monitoringdevice 5000 receives the response, processor 5004 executes instructionsof response upload module 5026 that cause patient monitoring device 5000to upload the response to monitoring server 5028 (5310).

After patient monitoring device 5000 uploads the response to monitoringserver 5028, processor 5004 may execute instructions of dataset downloadmodule 5020 that cause patient monitoring device 5000 to determinewhether monitoring server 5028 has another prompt to present to thepatient (5312). If monitoring server 5028 has another prompt to presentto the patient (“YES” of 5312), processor 5004 may execute instructionsof dataset download module 5020 that cause patient monitoring device5000 to download another prompt from monitoring server 5028 (5304), andso on.

On the other hand, if monitoring server 5028 does not have anotherprompt to present to the patient (“NO” of 5312), processor 5004 mayexecute instructions of dataset download module 5020 that cause patientmonitoring device 5000 to disconnect from monitoring server 5028 (5314).Processor 5004 may then terminate the patient monitoring session (5316).

Aspects of the disclosure described as being carried out by a computingsystem or are otherwise described as a method of control or manipulationof data may be implemented in one or a combination of hardware,firmware, and software. Embodiments of the invention may also beimplemented as instructions stored on a machine-readable medium, whichmay be read and executed by at least one processor to perform theoperations described herein. A machine-readable medium may include anymechanism for storing or transmitting information in a form readable bya machine (e.g., a computer). For example, a machine-readable medium mayinclude read-only memory (ROM), random-access memory (RAM), magneticdisc storage media, optical storage media, flash-memory devices,electrical, optical, acoustical or other form of propagated signals(e.g., carrier waves, infrared signals, digital signals, etc.), andothers.

The Abstract is provided to comply with 37 C.F.R. Section 1.72(b)requiring an abstract that will allow the reader to ascertain the natureand gist of the technical disclosure. It is submitted with theunderstanding that it will not be used to limit or interpret the scopeor meaning of the claims.

In the foregoing detailed description, various features are occasionallygrouped together in a single embodiment for the purpose of streamliningthe disclosure. This method of disclosure is not to be interpreted asreflecting an intention that the claimed embodiments of the subjectmatter require more features than are expressly recited in each claim.Rather, as the following claims reflect, inventive subject matter liesin less than all features of a single disclosed embodiment. Thus, thefollowing claims are hereby incorporated into the detailed description,with each claim standing on its own as a separate preferred embodiment.Therefore, the spirit and scope of the appended claims should not belimited to the description of the preferred versions contained herein.

The invention claimed is:
 1. A method comprising: pre-programming apatient monitoring device with a set of firmware instructions; storingthe set of firmware instructions in a memory of the patient monitoringdevice; repeatedly executing, on the patient monitoring device,instructions in the stored set of firmware instructions that cause thepatient monitoring device to: download a prompt from a monitoring servervia a communications network; store the prompt in the memory of thepatient monitoring device, wherein the prompt is associated with atleast one instruction in the set of firmware instructions, and whereinthe prompt causes the patient monitoring device to execute the at leastone instruction in the set of firmware instructions to gatherinformation relating to a patient; receive information relating to thepatient; upload the information, the information being uploaded to themonitoring server; wherein, after the patient monitoring device finishesexecuting instructions in the stored set of firmware instructions, thestored set of firmware instructions is the same as before the patientmonitoring device executed the instructions in the stored set offirmware instructions, and wherein repeatedly executing instructions inthe stored set of firmware instructions comprises: executing, on thepatient monitoring device, a first subset of the stored set of firmwareinstructions that cause the patient monitoring device to download afirst prompt; after executing the first subset of the stored set offirmware instructions, executing, on the patient monitoring device, asecond subset of the stored set of firmware instructions that cause thepatient monitoring device to store the first prompt in the memory of thepatient monitoring device, wherein the first prompt is associated with athird subset of the stored set of firmware instructions, and wherein thefirst prompt causes the patient monitoring device to execute the thirdsubset of the stored set of firmware instructions to gather informationrelating to a patient; after executing the second subset of the storedset of firmware instructions, executing, on the patient monitoringdevice, the third subset of the stored set of firmware instructions thatcause the patient monitoring device to gather information relating tothe patient; after executing the third subset of the stored set offirmware instructions, executing, on the patient monitoring device, afourth subset of the stored set of firmware instructions that cause thepatient monitoring device to upload the information; after executing thefourth subset of the stored set of firmware instructions, executing, onthe patient monitoring device, the first subset of the stored set offirmware instructions a second time, thereby causing the patientmonitoring device to download a second prompt; after executing the firstsubset of the stored set of firmware instructions the second time,executing the second subset of the stored set of firmware instructions asecond time, thereby causing the patient monitoring device to store thesecond prompt in the memory of the patient monitoring device, whereinthe second prompt is associated with the third subset of the stored setof firmware instructions, and wherein the second prompt causes thepatient monitoring device to execute the third subset of the stored setof firmware instructions a second time to gather further informationrelating to a patient; after executing the second subset of the storedset of firmware instructions the second time, executing the third subsetof the stored set of firmware instructions a second time, therebycausing the patient monitoring device to gather further informationrelating to the patient; and after executing the third subset of thestored set of firmware instructions the second time, executing thefourth subset of the stored set of firmware instructions a second time,thereby causing the patient monitoring device to upload the informationto the monitoring server.
 2. The method of claim 1, wherein repeatedlyexecuting the instructions further comprises executing instructions inthe stored set of firmware instructions that cause the patientmonitoring device to download prompts on a recurring basis.
 3. Themethod of claim 1, wherein the prompt, when executed, causes the patientmonitoring device to request the patient to provide an answer to aquestion.
 4. The method of claim 1, the method further comprising:receiving, at the patient monitoring device, a patient identifier, thepatient identifier being received from a patient identification device,the patient identification device being incorporated into the patientmonitoring device; and prior to executing the instructions in the storedset of firmware instructions, using, at the patient monitoring device,the patient identifier to identify the patient from among a plurality ofpatients; and wherein the prompt is specific to the patient.
 5. Themethod of claim 4, wherein receiving the patient identification datacomprises reading a patient identification card presented by thepatient.
 6. The method of claim 1, wherein the patient is an ambulatorypatient; and wherein a health care professional uses the response toremotely evaluate a health status of the patient.
 7. The method of claim1, wherein the prompt, when executed, causes-the patient monitoringdevice to automatically gather a physiological characteristic of thepatient from a sensor.
 8. A patient monitoring device comprising: aprocessor having a pre-programmed set of firmware instructions that,when executed by the processor of the patient monitoring device, causethe patient monitoring device to: download a prompt from a monitoringserver via a communications network; store the prompt in a memory of thepatient monitoring device, wherein the prompt is associated with atleast one instruction in the set of firmware instructions, and whereinthe prompt causes the patient monitoring device to execute the at leastone instruction in the set of firmware instructions to gatherinformation relating to a patient; receive information relating to thepatient; upload the information, the information being uploaded to themonitoring server; wherein, after the processor finishes executing thestored set of firmware instructions, the stored set of firmwareinstructions is the same as before the processor executed the stored setof firmware instructions, and wherein the stored set of firmwareinstructions comprise: a first subset of the stored set of firmwareinstructions that, when executed on the processor, cause the patientmonitoring device to download a first prompt; a second subset of thestored set of firmware instructions that, when executed on theprocessor, cause the patient monitoring device to store the first promptin the memory of the patient monitoring device, wherein the first promptis associated with a third subset of the stored set of firmwareinstructions, the third subset of the stored set of firmwareinstructions that, when executed on the processor, cause the patientmonitoring device to gather information relating to the patient; afourth subset of the stored set of firmware instructions that, whenexecuted on the processor, cause the patient monitoring device to uploadthe information; wherein after the processor executes the fourth subsetof the stored set of firmware instructions, the processor executes thefirst subset of the stored set of firmware instructions a second time,thereby causing the patient monitoring device to download a secondprompt, wherein the second prompt is associated with a fifth subset ofthe stored set of firmware instructions; wherein after the processorexecutes the first subset of the stored set of firmware instructions forthe second time, the processor executes the fifth subset of the storedset of firmware instructions, thereby causing the patient monitoringdevice to gather further information relating to the patient; andwherein after the processor executes the fifth subset of the stored setof firmware instructions, the processor executes the fourth subset ofthe stored set of firmware instructions a second time, thereby causingthe patient monitoring device to upload the further information to themonitoring sever.
 9. The patient monitoring device of claim 8, whereinthe stored set of firmware instructions further cause the processor toexecute the stored set of firmware instructions on a recurring basis.10. The patient monitoring device of claim 8, wherein the prompt, whenexecuted, causes the patient monitoring device to request the patient toprovide a physiological characteristic.
 11. The patient monitoringdevice of claim 8, wherein the stored set of firmware instructionsfurther cause the patient monitoring device to: receive a patientidentifier, the patient identifier being received from a patientidentification device, the patient identification device beingincorporated into the patient monitoring device; and prior to executingthe instructions in the stored set of firmware instructions, use thepatient identifier to identify the patient from among a plurality ofpatients; and wherein the prompt is specific to the patient.
 12. Thepatient monitoring device of claim 8, wherein the patient is anambulatory patient; and wherein a health care professional uses theresponse to evaluate a health status of the patient.
 13. A method ofoperating a patient monitoring device pre-programmed with a set offirmware instructions stored on memory in the device, the methodcomprising: receiving a command to initiate a patient monitoringsession; executing, on the patient monitoring device, a first subset ofinstructions in the stored set of firmware instructions that cause thepatient monitoring device to download a first prompt from a monitoringserver via a communications network, wherein the first prompt identifiesinstructions in the stored set of firmware instructions that cause thepatient monitoring device to gather data relating to the patient;executing, on the patient monitoring device, the instructions identifiedby the first prompt, thereby causing the patient monitoring device togather data relating to the patient; executing, on the patientmonitoring device, the first subset of instructions a second time in thestored set of firmware instructions that cause the patient monitoringdevice to download a second prompt from the monitoring sever via thecommunications network, wherein the second prompt identifiesinstructions in the stored set of firmware instructions that cause thepatient monitoring device to gather further data relating to thepatient; executing, on the patient monitoring device, the instructionsidentified by the second prompt; executing, on the patient monitoringdevice, instructions in the stored set of firmware instructions to causethe patient monitoring device to upload the data to the monitoringsever; and terminating the monitoring session with the patient.